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06 March 2024, Volume 39 Issue 3 Previous Issue   

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Expert consensus on integrated traditional Chinese and western medicine in the diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children（2023）  Children's Pneumonia Collaborative Innovation Community, Chinese Society of Traditional Chinese Medicine, Children's Health and Drug Research Professional Committee, China Association of Traditional Chinese Medicine, Editorial Board of Chinese Journal of Practical Pediatrics 2024, 39(3): 161-167.  DOI: 10.19538/j.ek2024030601 Abstract ( )   Mycoplasma pneumoniae pneumonia （MPP） involves many aspects in clinical practice， especially in pathogen diagnosis， rational use of antibiotics， diagnosis and treatment of refractory MPP， as well as the prognosis and long-term management of MPP. It has become a hot topic in clinical practice and research. The advantages of integrated traditional Chinese and western medicine in the treatment， early intervention， and improvement of prognosis of MPP in the acute phase are gradually emerging. In order to standardize the diagnosis and treatment of MPP， some domestic experts in this field， combining recent progress and evidence-based evidence， have comprehensively revised the Expert Consensus on Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Mycoplasma Pneumoniae Pneumonia in Children （2017）， In order to better solve clinical problems in the diagnosis and treatment of MPP and promote the progress of integrated traditional Chinese and western medicine.

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Treatment strategies for child cardiomyopathy （2023 edition）： Interpretation of an American Heart Association scientific statement LI Ya, ZHU Li-qin, HE Wei-mei, et al 2024, 39(3): 168-174.  DOI: 10.19538/j.ek2024030602 Abstract ( )   In 2023， the American Heart Association（AHA） issued a scientific statement on the treatment strategies for child cardiomyopathy， focusing on dilated and hypertrophic cardiomyopathies， which addresses the lack of treatment options for children-specific cardiomyopathies and provides options based on the AHA perspective. The purpose of this paper is to interpret this scientific statement in order to provide an AHA-based decision-making evidence for domestic colleagues to develop treatment programs for children with cardiomyopathies.

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Interpretation of the EASO and EFAD position statement on medical nutrition therapy for overweight and obesity in children and adolescents ZHAO Shi-guo, YANG Zi-hao, CHEN Zhen-jie, et al 2024, 39(3): 175-182.  DOI: 10.19538/j.ek2024030603 Abstract ( )   In January 2023， the European Association for the Study of Obesity （EASO） and the European Federation of the Associations of Dietitians （EFAD） jointly issued a position statement on medical nutrition therapy for overweight or obesity in children and adolescents. It is based on the best evidence in the literature （randomized controlled trial，meta-analysis，systematic review）， and the evidence presented in the joint position statement confirms that dietary intervention can effectively improve obesity-related results. This paper interprets the best evidence summary （evidence statement） and recommended content in the joint position statement and the situation facing China.

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Progress in the etiology and pathogenesis of myocarditis in children SUN Shu-na 2024, 39(3): 183-192.  DOI: 10.19538/j.ek2024030604 Abstract ( )   Myocarditis is a common disease in children.Myocarditis is a disease characterized by localized or diffuse inflammatory lesions in the myocardial tissue，primarily manifested by myocardial cell necrosis and inflammatory cell infiltration in the interstitium.The etiology of myocarditis includes infectious and non-infectious causes.Viral infections have been proven to be the most common infectious cause，while autoimmune factors and drugs play a major role in non-infectious causes.The pathogenesis of myocarditis involves direct and secondary damage to myocardial cells，immunological mechanisms，abnormal gene signaling pathways，miRNA，genetic susceptibility，and other factors.In recent years，there has been considerable attention given to myocarditis due to the global pandemic of the novel coronavirus and the widespread application its vaccine .This article elaborates on the current research status and progress of the etiology and pathogenesis of myocarditis.

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Imaging examination of myocarditis in children XIONG Zhen-yu, JIN Na, LI Xiang-ying, et al 2024, 39(3): 193-198.  DOI: 10.19538/j.ek2024030605 Abstract ( )   Myocarditis is the inflammation of myocardial tissue. Cardiac imaging examinations can objectively reflect the histological characteristics and functional status of the heart in myocarditis.The electrocardiogram is widely used as a preliminary screening tool for myocarditis. Echocardiography is the first-line and most common imaging method for evaluating the cardiac structure and function of patients with suspected myocarditis because it can quickly and timely assess the myocardial damage and severity. Cardiac magnetic resonance （CMR） can accurately detect damage and edema in myocarditis， increasingly replacing endomyocardial biopsy （EMB） in the diagnosis of acute myocarditis. Radionuclide myocardial imaging can detect inflammatory infiltration and necrosis， as well as evaluate myocardial viability and perfusion，which is of high vaue in the diagnosis of myocarditis. The use of imaging examinations， combined with comprehe-nsive clinical analysis， plays an important role in the accurate diagnosis and treatment of myocarditis.

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Progression of markers for myocarditis in children CHEN Ya-na, CHEN Ming-wu 2024, 39(3): 198-203.  DOI: 10.19538/j.ek2024030606 Abstract ( )   Myocarditis is a local or diffuse myocardial inflammatory disease， which is identified by histological and immunological methods. Clinically， the "gold standard" for the diagnosis of myocarditis has been endocardial biopsy. But it lacks the advantage of early diagnosis， which is an important cause of the death due to myocarditis.The detection of myocardial markers possesses the characteristics of being early， rapid and convenient， thus providing certain value for the early diagnosis， the understanding of the condition and also the evaluation of curative effect in myocarditis patients. At present， common myocardial markers are mostly used for the diagnosis and treatment of adult heart-related diseases. Due to the immaturity of myocardial function and the particularity of growth and development in children， the pathogenesis and pathophysiological process of myocardial injury in children are very different from those in adults. Up to now， there is no clear application value of pediatric myocardial markers. As a result，this article reviews the research progress of markers with myocarditisin in children.

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Progress in diagnosis and treatment of fulminant myocarditis in children TUO Hu, HE Bing 2024, 39(3): 203-207.  DOI: 10.19538/j.ek2024030607 Abstract ( )   Fulminant myocarditis in children is the most serious type of childhood myocarditis， which progresses rapidly and can be manifested as heart failure， cardiogenic shock and severe arrhythmia， endangering the life of children. Once the disease is suspected， it needs great attention， rapid diagnosis， multi-professional cooperation， and all-out treat-ment. Under the promotion of the Myocarditis Collaboration Group of the Cardiovascular Group of the Chinese Academy of Pediatrics， China updated the expert recommendations on the diagnosis of childhood myocarditis in 2018， and has subsequently organized national pediatric cardiovascular experts to carry out discussions and lectures on the diagnosis and treatment of fulminant myocarditis a number of times. The diagnosis and treatment of fulminant myocarditis in children has been improved and rich experience has been accumulated in various medical centers. This article reviews the progress in diagnosis and treatment of fulminant myocarditis in children.

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Factors affecting the prognosis of children with myocarditis XIE Ying-ying, XIONG An-xiu, LU Wei 2024, 39(3): 207-211.  DOI: 10.19538/j.ek2024030608 Abstract ( )   Myocarditis in children is an inflammatory disease of the heart muscle caused by a variety of infections or other causes. The clinical manifestations are various and non-specific， ranging from mild chest discomfort without other symptoms to cardiogenic shock，and the natural history of myocarditis ranges from full recovery to progression to cardiomyopathy and even death. The variety and non-specific clinical manifestations of myocarditis and the complexity in diagnosis and treatment options result in the significant heterogeneity of its prognosis. Therefore， it is of great significance to study the factors related to the prognosis of children with myocarditis.

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Clinical characteristics of COVID -19 associated myoc -ardial injury/myocarditis in children HAN Yong, PANG Yu-sheng 2024, 39(3): 211-216.  DOI: 10.19538/j.ek2024030609 Abstract ( )   COVID-19 might have a direct and indirect effect on the cardiovascular system. The relevant mechanisms include virus direct invasion， inflammatory factor storm， hypoxemia induced myocardial hypoxia injury and immune disorders. Novel coronavirus infection in children can lead to cardiovascular complications such as myocardial damage， myocarditis， arrhythmia and multi-system inflammatory syndrome. Compared with other viral cardiomyopathies， COVID-19 related cases have a more insidious onset， a higher proportion of fulminant myocarditis， and persistent symptoms after the infection period. In addition， children with COVID-19 who have pre-existing underlying cardiovascular disease have a worse prognosis than previously healthy children. This article reviews the clinical features， mechanisms and management of novel coronavirus infection-related myocardial damage/myocarditis in children.

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Research progress in the correlation between myocarditis and gene polymorphism in children LI Wen-jing , LI Xiao-ou, HE Bing 2024, 39(3): 216-222.  DOI: 10.19538/j.ek2024030610 Abstract ( )   Myocarditis is an inflammatory disease of myocar-dium caused by various pathogenic factors. The clinical manifestations of myocarditis in children are complex and varied， and the severity of the disease varies. Because the onset of myocarditis is hidden， early diagnosis and timely treatment are particularly important to improve the prognosis of myocarditis. Gene polymorphism plays an important role in the occurrence and development of myocarditis in children. In this paper， we introduced the research progress on the relationship of the gene polymorphisms of Coxsackie-adenovirus receptor， human leukocyte antigen， matrix metalloproteinases， inducible nitric oxide synthase， IL-17， vitamin D receptor， monocyte chemoattractant protein -1 and  non-coding RNA with myocarditis， hoping to help understand the pathogenesis of myocarditis in children better， do a good job in screening and preventing susceptible people， and provide new ideas for early diagnosis and treatment of myocarditis in children.

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Clinical features and risk factors of fulminant myocarditis in children CHEN Jing, HE Shuang, ZHENG Min, et al 2024, 39(3): 223-230.  DOI: 10.19538/j.ek2024030611 Abstract ( )   Objective    To investigate the early clinical features and risk factors of fulminant myocarditis in children， and to provide clinical experience for the early identification of fulminant myocarditis. Methods    The clinical data of 51 children with fulminant myocarditis and 62 children with acute myocarditis admitted to the Children's Hospital of Chongqing Medical University from January 2015 to January 2022 were retrospectively analyzed. Results    （1） The age at the onset of the disease in the fulminant myocarditis group was older， with the incidence of Asian seizures， dizziness， headache， dyspnea， nausea， vomiting， abdominal pain， bloating， oliguria， altered consciousness， low heart sounds， irregular heartbeat， cold extremities， facial changes， and liver enlargement being greater than that in the acute myocarditis group （P<0.05）. （2） Compared with the acute myocarditis group， white blood cell count， C-reactive protein， hypertroponin I， creatine kinase isoenzyme MB type， lactate dehydrogenase， alanine aminotransferase， aspartate aminotransferase， blood creatinine， blood urea nitrogen， albumin， left heart function， cardial enlargement ventricular septum， wall mobility and thickness， pericardial effusion， moderate and severe regurgitation of the ditricuspid valve， ventricular tachycardia， escape beat， ventricular fibrillation/ventricular arrest， third-degree atrioventricular block， and bundle branch block in the fulminant myocarditis group had significant differences （P<0.05）， but there was no significant difference in the detection rate of various etiologies between the two groups （P>0.05）. （3） Logistic regression analysis showed that albumin， left ventricular ejection fraction， third-degree atrioventricular block， and bundle branch block were predictive risk factors for fulminant myocarditis；Logistic regression equation P=1/［1+e-（92.862-0.171×ALB-0.351×LVEF+6.286×Ⅲ°atrioventricular block+5.492×bundle branch block）］， sensitivity was 94.1% and specificity was 96.8%，with good discrimination. （4） Children with fulminant myocarditis were given comprehensive treatment such as immune regulation， anti-arrhythmia， anti-heart failure， and anti-infection， and 3 children （5.8%） died. Conclusion    The clinical manifestations of fulminant myocarditis in children are atypical， with low albumin in the early stage， decreased left ejection fraction， third-degree atrioventricular block and bundle branch block being predictive risk factors for fulminant myocarditis.

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Clinical features of corona virus disease in children：An analysis of 188 cases XIONG Shu-ping, YE Xiao-qing, CHEN Li-li, et al 2024, 39(3): 231-234.  DOI: 10.19538/j.ek2024030612 Abstract ( )   Objective    To study the clinical features of children with coronavirus disease. Methods    A retrospective analysis was performed on the medical data of 188 hospitalized children diagnosed with novel coronavirus infection in the First Affiliated Hospital of Xiamen University from December 2022 to March 2023. Divide them into mild group （34 cases）； moderate group （75 cases）， and severe or critical group （79 cases）； compare their clinical features，results of experimental examinations and outcomes. Results    The proportion of endocrine and nutritional metabolic disorders in the severe or critical group was higher than that in the mild group and the moderate group， the proportion of respiratory and nervous system disease was higher than that in the moderate group， the proportion of premature birth and dysplasia diseases was higher than that in the mild group， and the proportion of hematologic system diseases and immune  system diseases was lower than that in the mild group（P<0.05）. The fever peak washigher in severe or critical group， and the incidence of cough in moderate group was higher than that in mild group （P<0.05）. The white blood cell count was higher in severe or critical group than in mild group，C-reactive protein and procalcitonin were higher in severe or critical group than those in mild group and moderate group， and IL-6 was higher and the percentage of lymphocyte was lower than those in moderate group （P<0.05）. The rate of bacterial coinfection in severe or critical group was higher than that in mild group. Finally， three children died， while the rest were discharged after getting better. Conclusion    The increased proportion of children in severe condition or with basic diseases，complex coinfection and comorbidity pose greater challenges to disease diagnosis and treatment. The increase in white blood cell count， C-reactive protein， calcitonin and IL-6， and the decrease in lymphocyte ratio may indicate the aggravation of the disease. For children with respiratory and nervous system diseases， premature delivery and abnormal growth diseases and endocrine and nutritional metabolic disorders， it is necessary to be alert to the possibility of severe diseases. For children with other types of basic diseases， it is necessary to be alert to the impact of SARS CoV-2 infection on their basic diseases.

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Clinical report on 5 cases of infantile glycogen storage disease Ⅱ and literature review DAI Xiao-juan, ZHENG Li-ling, ZHANG Jia-xiang 2024, 39(3): 235-240.  DOI: 10.19538/j.ek2024030613 Abstract ( )   A total of 5 children with infantile glycogen storage disease type Ⅱ were treated in Zhangzhou Hospital of Fujian Province from November 2016 to March 2022. Among the 5 cases， 3 were male and 2 were female， and the age of onset was less than 1 year. The first symptoms were dyspnea， cardiac hypertrophy， liver enlargement and skeletal muscle weakness.The serum acidus-glucosidase concentration in 4 cases was significantly reduced， with the minimum being 0.28 mol/ （L·h）. Genetic tests were performed on 5 cases， of which 3 were homozygous missense mutations， 1 was heterozygous missense mutations， and 1 was complex heterozygous missense mutations. At the same time， the right ventricular arrhythmia-inducing cardiomyopathy gene CTNNA3 mutation C.2122A>G paternal source was present. All 5 cases died after being discharged automatically. The median survival time was 11 months （6-11 months）. Among the confirmed cases， c.1935C>A was the most common type of gene mutation， and c.2853G>A may be a new pathogenic mutation site.