Hunan Children's Hospital

Clinically, recurrent polyp growth is a characteristic feature of pediatric Peutz-Jeghers syndrome (PJS) patients. However, the clinical characteristics of pediatric PJS patients grouped by postoperative recurrence time remain undefined. Furthermore, differences in clinical features between serine/threonine kinase 11 (STK11)-positive and -negative patients, and the influence of STK11 mutation types on polyp recurrence time need to be elucidated. Our study aimed to characterize pediatric PJS based on postoperative polyp recurrence time and STK11 mutation status. We collected clinical data from 74 pediatric PJS patients diagnosed at Hunan Children's Hospital over the past decade. STK11 genomic profiling was performed using Sanger sequencing combined with multiplex ligation-dependent probe amplification (MLPA) or whole exome sequencing (WES). Variables associated with gastrointestinal polyp recurrence were identified through least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate logistic regression analysis of significant variables. All 74 pediatric PJS patients who experienced polyp recurrence post-polypectomy were stratified by recurrence time (>3, 1-3, and ≤1 year). Notably, 49.2% (31/63) of STK11-positive (STK11pos) patients recurred within ≤1 year after polypectomy, while 81.8% (9/11) of STK11-negative (STK11neg) patients with recurrence >3 years after polypectomy. LASSO and multivariate logistic regression identified multiple jejunal polyps (odds ratio [OR]: 4.18, 95% confidence interval [CI]: 1.09-15.98) and giant small bowel polyps (OR: 4.06, 95% CI: 1.15-14.34) as independent risk factors for recurrence ≤1 year after polypectomy. Compared to STK11neg patients, STK11pos patients, especially when combined with a positive PJS family history exhibited significantly earlier symptom onset, higher gastrointestinal giant polyp burden, and higher polyp burden in the jejunum/colon versus ileum. Analysis of 63 STK11pos patients revealed diverse mutation types/sites and identified 15 novel pathogenic variants. STK11pos patients with de novo mutations exhibited a significantly higher incidence of hematochezia, along with a greater overall burden of giant polyps in the colon. No significant association was found between major mutation subtypes (frameshift, missense, deletion, and nonsense) and recurrence time, though missense mutations showed a trend toward earlier recurrence. This study reveals distinct clinical profiles across polyp recurrence intervals and between STK11-positive and -negative patients, while delineating the STK11 mutation landscape in pediatric PJS. These findings provide the genomic resource for pediatric PJS, offering critical insights into disease mechanisms and clinical management.

<title>Abstract</title> <bold>Objective:</bold> Differentiating septic arthritis from transient synovitis in children is challenging. This study aimed to determine the diagnostic value for distinguishing these two conditions and to develop an effective clinical prediction model based on multi-center clinical data to identify and differentiate between the two diseases more comprehensively and accurately. <bold>Methods:</bold> We retrospectively analyzed data of children aged under 18 years who were hospitalized in eight specialized children's hospitals in China from 2013 to 2021. The data included age, sex, initial hospital admission temperature, history of prodromal respiratory infection, prodromal history of strenuous exercise, etc. Laboratory test results, including that of erythrocyte sedimentation rate (ESR), serum white blood cell count (WBC), C-reactive protein (CRP), platelet count (PC), pathogenic bacterial count and other information. The common sites of bone and joint infection in children are the hip and knee joints. Therefore, to ensure the prediction model's reliability, we established three clinical prediction models: one for septic hip arthritis and transient hip synovitis, one for septic knee arthritis and transient knee synovitis, and one for septic arthritis and transient synovitis in either joint which we merged all the data of the hip and knee joints into one data set to build a clinical prediction model. In addition, we conducted single-factor and multi-factor analyses on the data classified by these models. <bold>Results:</bold> This study collected data of 819 children from 8 tertiary children's hospitals, including 265 patients with septic arthritis (mean age 5.55±7.16 years) and 554 patients with transient synovitis (mean age 4.8±3.2 years). In 265 blood and joint aspirate cultures of septic arthritis, the most common causative organism was Staphylococcus aureus (59%). To ensure the quality and reliability of the prediction models, we established three clinical prediction models. For septic hip arthritis, a retrospective study based on six clinical predictors was a history of prodromal respiratory tract infection (HRTI), temperature&gt;37.5 ºC, ESR&gt;20 mm/h, CRP&gt;10 mg/L, red blood cell distribution width (RDW)&gt;50%, and WBC&gt;11×109 /L. When these six factors were present, the probability of septic hip arthritis was 99.99%. For septic knee arthritis, a retrospective study based on three clinical predictors, the predictors were ESR&gt;20 mm/h, CRP&gt;10 mg/L, and absolute monocyte count (AMONO)&gt;0.74×109/L. When these three factors were present, the probability of having septic knee arthritis was 94.68%. For septic arthritis (septic hip arthritis or septic knee arthritis), a retrospective study based on six clinical predictors, the predictors were male children, history of HRTI), temperature&gt;37.5 ºC, ESR&gt;20 mm/hr, PC &gt; 407×10 ⁹ /L and CRP&gt;10 mg/L. When these six factors were present, the probability of septic arthritis was 99.65%. <bold>Conclusion:</bold> This study used multi-center clinical data to construct a new clinical prediction model for children with septic arthritis. The clinical prediction model algorithm developed here outperformed that of previous studies in the probability of diagnosing septic arthritis. In addition to considering body temperature, WBC, ESR, and CRP, we identified new clinical predictors such as sex, history of HRTI, RDW, PC and AMONO.

BackgroundMetagenomic next-generation sequencing (mNGS) plays a critical role in the rapid detection of infectious pathogens. We aimed to analyze the clinical characteristics of Pneumocystis jirovecii infection in children without HIV infection and to evaluate the performance of mNGS in distinguishing P. jirovecii colonization from true infection.MethodsA multicenter, retrospective analysis was conducted on critically ill, non-HIV-infected pediatric patients who tested positive for P. jirovecii via mNGS analysis of bronchoalveolar lavage fluid (BALF). Group differences were assessed using Mann–Whitney U-tests (for continuous data) and chi-square tests (for categorical data). Discriminatory performance was evaluated by calculating the area under the receiver operating characteristic curve.ResultsA total of 59 HIV-negative children (age range: 2 months to 14 years) from four children’s hospitals were included and classified into two groups based on P. jirovecii status: P. jirovecii pneumonia (PCP; n = 51) and P. jirovecii colonization (PCC; n = 8). Compared with the PCC group, the PCP group had significantly higher serum C-reactive protein levels and median P. jirovecii read counts in mNGS (both P < 0.05). The optimal threshold value for discriminating P. jirovecii infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%). Eighteen patients (35.3%) in the PCP group died. Compared with survivors, these patients were significantly younger, had lower T-cell subset counts (CD3+, CD4+, and CD8+), and a higher prevalence of primary immunodeficiency (all P < 0.05).ConclusionsBALF mNGS analysis may have utility for differentiating between colonization and infection by P. jirovecii, warranting further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12890-026-04163-9.

Pediatric Atopic dermatitis (AD) is a common, relapsing inflammatory skin disease in children. While linked to vitamin D deficiency, the roles of T-cell senescence and vitamin D receptor (VDR) signaling remain unclear. To explore vitamin D status, VDR expression (soluble/sVDR, membrane/mVDR, nuclear/nVDR), and T-cell senescence in pediatric AD. Serum 25-hydroxyvitamin D (25(OH)D) levels were analyzed in 408 pediatric AD patients and matched controls. In a subset (89 patients, 35 controls), plasma sVDR was measured by ELISA. T-cell immunophenotyping, senescence markers (CD27-CD28-), and mVDR/nVDR expression were assessed via flow cytometry. Children with AD had significantly lower serum 25(OH)D (p<0.05) and sVDR (p<0.05). Although major T-cell subset proportions were similar, children with AD showed expanded senescent populations within CD3⁺ (p<0.01), CD8⁺ (p<0.05), CD4⁺ (p<0.05), and Regulatory T (Treg) cells (p<0.01). mVDR expression was pervasively reduced across all immune cells in pediatric AD (for CD3-, CD3+ and CD8+: p<0.0001; for CD4+, T follicular helper (Tfh) cells: p<0.001; for Treg: p<0.01). Senescent cells expressed higher mVDR than non-senescent cells in both groups (NC: CD3-, p<0.0001; CD3+ and CD8+, p<0.01; CD4+, p<0.001. AD: CD3-, CD3+, CD8+ and CD4+, p<0.0001), yet overall children with AD exhibited lower mVDR levels both in non-senescent and senescent cells (non-senescent cells: CD3-, p<0.001; CD3+ and CD4-, p<0.0001; CD4+, p<0.01. senescent cells:CD3-, CD3+ and CD8+, p<0.0001; CD4+, p<0.01). nVDR alterations were more limited, with elevation only in Tfh cells (p<0.05) of children with AD. Pediatric AD is characterized by accelerated T-cell senescence and a widespread mVDR pathway deficiency. This receptor defect, coupled with vitamin D deficiency, may drive immune dysregulation and premature T-cell aging, highlighting potential therapeutic targets in both ligand and receptor pathways.

BackgroundInternet addiction has reached an alarming level in Chinese children, yet the mechanisms linking parenting styles to Internet addiction remain unclear in the Chinese context characterized by intense academic competition and parental authority.ObjectiveThis study examined how Baumrind’s parenting styles—conceptualized as a culturally meaningful framework in Chinese contexts where high parental demands coexist with varying levels of warmth—influence children’s Internet addiction through sequential mediation of self-control and rejection sensitivity, with achievement motivation—particularly salient during primary school years when motivational orientations develop—as a moderator. Baumrind’s parenting style framework provides a culturally meaningful lens for examining parenting patterns in Chinese families, particularly in contexts characterized by high parental demands.MethodsThis cross-sectional study included a sample of 661 grade 4–6 children (Mage = 11.23 years) from central China who completed measures of parenting styles, self-control, rejection sensitivity, achievement motivation, and Internet addiction. The moderated sequential mediation model was tested using PROCESS Model 88.ResultsAuthoritative parenting negatively predicted Internet addiction, whereas authoritarian parenting positively predicted it. Permissive parenting showed no direct effect but significantly reduced self-control. Self-control acted as an independent mediator and enabled rejection sensitivity to serve as a subsequent mediator across all parenting styles. Achievement motivation moderated the self-control → Internet addiction path (enhancing protection) and the rejection sensitivity → Internet addiction path (buffering risk). The self-control mediation pathway showed opposite moderation patterns: positive for authoritative parenting but negative for authoritarian and permissive parenting.ConclusionThese findings challenge traditional authoritarian practices and highlight the benefits of authoritative parenting that integrates guan (discipline) with warmth. They underscore the need for multi-level interventions combining parent education with programs fostering children’s self-control and achievement motivation in culturally grounded family contexts.

The liver, the largest glandular organ in humans, exhibits a unique and robust regenerative capacity following injury. This regenerative response is orchestrated through a highly regulated network of cellular and molecular signals. Here, we review the cytokine-mediated regulation of liver regeneration, emphasizing autocrine, paracrine, as well as endocrine pathways. Hepatocyte proliferation is modulated not only by intrinsic signals but also by cytokines derived from non-parenchymal cells—including Kupffer cells, hepatic stellate cells, and liver sinusoidal endothelial cells—as well as by endocrine cues from the systemic circulation. From the perspective of metabolic reprogramming, these regulatory pathways illustrate how adaptive changes in glucose, lipid, and amino acid metabolism collectively sustain the cellular activities essential for liver regeneration. We further explore how metabolic adaptations contribute to regeneration, providing mechanistic insights and revealing potential therapeutic targets for liver diseases. Finally, we discuss emerging strategies that target cytokine networks and metabolic pathways to enhance liver regeneration, highlighting recent advances in translational applications.

BackgroundAtopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition that affects approximately 10% to 20% of children, imposing substantial health and economic burdens. Although education for patients and caregivers is acknowledged as a crucial element in the management of AD, conventional approaches, such as workshops or in-person consultations, are often resource intensive and face challenges related to scalability, personalization, and relapse prevention. Digital tools present promising alternatives; however, empirical evidence supporting their effectiveness in young children is currently limited.ObjectiveThis study aimed to evaluate whether a smartphone-based patient-caregiver educational program could reduce relapse rates in children aged 0 to 6 years with moderate-to-severe AD, compared with conventional outpatient consultation alone.MethodsIn this multicenter, randomized, parallel-controlled trial, 615 children were enrolled across 12 tertiary pediatric dermatology centers in China and randomized (1:1) to receive either a smartphone-based digital education program with standard care (intervention group) or conventional face-to-face consultation only (control group). The 12-week digital program, delivered via the WeChat-based Skin Care E-Station platform, included structured multimedia modules, interactive educational materials, and a dynamic electronic action plan tailored to the child’s age and disease stage. The primary endpoint was the 12-week relapse rate after the acute treatment phase. The secondary endpoints included changes in disease severity (Scoring Atopic Dermatitis, Peak Pruritus Numerical Rating Scale, and Patient-Oriented Eczema Measure) and quality of life (Children’s Dermatology Life Quality Index or Infant’s Dermatitis Quality of Life Index and Dermatitis Family Impact) up to 52 weeks.ResultsAmong 615 randomized participants (mean age 3.3, SD 1.7 y; n=317, 51.5% male), relapse at 12 weeks occurred significantly less frequently in the digital education group than in the control group (16.6% vs 24.0%; relative risk 0.69, 95% CI 0.50‐0.96; P=.02). Kaplan-Meier analysis showed superior relapse-free survival over the first 100 days (hazard ratio 0.688, 95% CI 0.490‐0.966; P=.03). Differences in relapse rates beyond 12 weeks and in secondary outcomes were not statistically significant. Engagement tracking indicated high adherence to the intervention, with 58.0% of caregivers maintaining regular weekly use of the digital platform.ConclusionsA structured smartphone-based patient-caregiver educational intervention significantly reduced short-term relapse risk among young children with moderate-to-severe AD, likely through improved caregiver recognition and early management of disease flares. Although effects diminished beyond 12 weeks, this approach demonstrates that scalable digital education is a feasible and effective adjunct to standard care in pediatric AD. Future research should focus on sustaining engagement, optimizing long-term reinforcement, and assessing cost-effectiveness in diverse caregiver populations.

Pediatric hemophagocytic lymphohistiocytosis (HLH) patients who develop disseminated intravascular coagulation (DIC) experience rapid disease progression and substantially elevated mortality. Currently, no validated early identification strategies exist for this life-threatening complication. We aimed to develop a prediction model for early DIC detection in pediatric HLH patients. This retrospective cohort study included patients from the Hunan Children's Hospital HLH database (January 2018-August 2024). Data imbalance was addressed through combined oversampling and undersampling techniques, including Synthetic Minority Over-sampling Technique (SMOTE). The cohort was divided into training and validation sets (7:3 ratio). A LASSO-logistic regression model was developed and validated internally, with external validation using prospectively collected cases (January-August 2025). Model performance was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis. Of 265 included patients, 217 cases were analyzed after SMOTE application. DIC incidence was 42.1% (64/152) and 44.6% (29/65) in training and validation cohorts, respectively. LASSO regression (lambda.1se=0.08) identified six potential predictors: C-reactive protein (CRP), globulin, cholesterol, high-density lipoprotein cholesterol, prothrombin time (PT), and interferon-γ (IFN-γ). Multivariable logistic regression confirmed three independent predictors: CRP, PT, and IFN-γ (all P<0.05). The model demonstrated robust discriminative performance with area under the receiver operating characteristic curve (AUROC) of 0.865 (95% CI: 0.809-0.922) in the training cohort and bootstrap-corrected C-index of 0.857 (95% CI: 0.828-0.886). Internal validation yielded AUROC of 0.797 (95% CI: 0.686-0.908), whereas external validation achieved an AUROC of 0.950. Decision curve analysis showed positive net benefit across threshold probabilities of 0%-99% in training and 0%-88% in validation sets. The LASSO-logistic prediction model, incorporating three readily available biomarkers, demonstrated promising discriminative ability for predicting DIC risk in pediatric HLH. This tool may facilitate early risk stratification and timely therapeutic interventions to improve clinical outcomes.

BackgroundHirschsprung's disease (HSCR) is the second most common congenital gastrointestinal malformation, posing a significant health concern in pediatrics. The laparoscopic modified Soave procedure, a minimally invasive technique, has gained popularity due to its potential advantages. This study aimed to evaluate its clinical efficacy in comparison with the traditional transanal Soave procedure.MethodsThis comparative retrospective cohort study included children with HSCR treated at Qilu Hospital between January 2014 and January 2024. The patients were divided into the following two groups: the Laparoscopic group (those who underwent the laparoscopic modified Soave procedure) and the Transanal group (those who underwent the transanal Soave procedure). The assessed outcomes included postoperative recovery metrics, complication rates, and 1-year follow-up results.ResultsIn total, 96 patients were included in the study. Compared with the Transanal group, the Laparoscopic group demonstrated reduced surgical time, faster gastrointestinal recovery, and reduced hospital stay duration (P < 0.05). Intraoperative blood loss was greater in the Laparoscopic group (P < 0.05). Complication rates were lower in the Laparoscopic group (4.17%) than in the Transanal group (14.58%), although the difference was not statistically significant (P > 0.05). Notably, the incidence of postoperative abdominal distension was lower in the Laparoscopic group (P < 0.05), but no significant differences observed in multivariate analysis of postoperative outcomes (P < 0.05).ConclusionThe laparoscopic modified Soave procedure demonstrated superior clinical efficacy compared to the transanal approach, offering faster recovery and a trend toward fewer complications. These findings support its wider adoption as a minimally invasive treatment option for HSCR.