ABSTRACT Importance Major depressive disorder (MDD) significantly impairs psychological well‐being and social functioning in adolescents. While pharmacotherapy is the most commonly used first‐line treatment in current clinical practice, its limitations highlight the need for complementary approaches. Objective This study aimed to compare dance movement therapy (DMT) combined with pharmacotherapy to pharmacotherapy alone in terms of their effects on the severity of depressive symptoms, anxiety symptoms, and self‐esteem in adolescents with MDD. Methods Eighty adolescents with MDD from Beijing Huilongguan Hospital were randomly assigned to either an intervention group (DMT and pharmacotherapy, n = 40) or a control group (pharmacotherapy alone, n = 40). Participants completed the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Rosenberg Self‐Esteem Scale at baseline and after the 6‐week intervention period. Results For depressive symptoms, repeated‐measures analyses of variance revealed a significant main effect of time, F (1, 78) = 180.50, P < 0.001, partial η 2 = 0.698, as well as a significant time × group interaction, F (1, 78) = 17.20, P < 0.001, partial η 2 = 0.181. For both anxiety symptoms and self‐esteem, a significant main effect of time was observed, but the time × group interaction was not significant. Interpretation DMT combined with pharmacotherapy improved depression symptoms more than pharmacotherapy alone, but this enhanced effect was not observed for anxiety symptoms or self‐esteem.

To the Editor: Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) represents a severe T cell–mediated reaction frequently complicated by viral reactivation, including human herpesvirus 6 (HHV-6).1 While autoimmune sequelae such as thyroiditis are recognized, gastrointestinal manifestations are rarely documented.2 We report the first endoscopically and histopathologically confirmed exacerbation of Crohn's disease (CD) following DIHS in a patient with preexisting CD. A 16-year-old boy with a 3-year history of ileocolonic CD was maintained on mesalazine (5-aminosalicylic acid) and azathioprine. Because of persistent rectal inflammation (Figure 1A), aminosalicylic acid was substituted with salazosulfapyridine (SASP). After two weeks, he developed pyrexia, independently discontinued SASP, and the fever subsided within four days. One week later, he presented with pyrexia (>38°C); a diffuse, milia-sized papular eruption with facial edema (Figure 1B–D); and cervical, axillary, and inguinal lymphadenopathies. Marked hepatic involvement and elevated inflammatory markers, including thymus and activation-regulated chemokines, were observed. Skin biopsy revealed necrotic keratinocytes, spongiosis, and interface dermatitis with lymphocytic infiltration (Figure 1E). Serological testing for Epstein-Barr virus, human immunodeficiency virus, syphilis, and cytomegalovirus (CMV) was negative. Serum polymerase chain reaction (PCR) detected HHV-6 DNA, fulfilling the criteria for typical DIHS.3 Prednisolone (1 mg/kg/day) achieved prompt cutaneous remission. Tapering prednisolone to 0.5 mg/kg/day triggered the emergence of bloody diarrhea, pyrexia, rash recrudescence, and newly positive thyroid autoantibodies. Colonoscopy demonstrated scattered erosions in the ileum and continuous granular edematous mucosa, hemorrhage, and white plaques. Biopsies of the colon, stomach, and duodenum revealed cryptitis and crypt abscesses consistent with CD flare (Figure 1F). Quantitative PCR for HHV-6A and HHV-6B performed on colonic biopsy specimens from CD lesions, obtained pre- and post-DIHS onset, was negative. Immunostaining and peripheral blood DNA testing excluded CMV colitis. The flare was considered a post-DIHS immune reconstitution phenomenon. Cyclosporine (5 mg/kg/day)-prednisolone combinatorial treatment controlled both skin and bowel inflammation, but hematochezia recurred with dose reduction. Vedolizumab, indicated for refractory CD, induced sustained remission, and steroids and cyclosporine were withdrawn. The patient remained asymptomatic on vedolizumab monotherapy. DIHS may trigger comorbidities or exacerbate preexisting autoimmune, autoimmune-related, and infectious diseases.2 The present case necessitated escalation to vedolizumab to manage complications of underlying CD, suggesting that DIHS may aggravate preexisting inflammatory bowel diseases (IBD), particularly during steroid tapering or intravenous immunoglobulin administration, which may prompt immune reconstitution inflammatory syndrome. Although gastrointestinal involvement in DIHS is infrequently reported, the current case, a systematic review identifying 21 cases of DIHS-associated colitis (not endoscopically verified),4 and an account of endoscopically verified de novo Crohn’s-like colitis,5 emphasize the need for heightened awareness of gastrointestinal symptoms in DIHS. Clinicians should monitor gastrointestinal symptoms long-term in DIHS/DRESS, especially in patients with preexisting IBDs. We thank the Department of Infectious Disease Pathology, National Institute of Infectious Diseases, Japan Institute for Health Security, for their technical assistance with HHV-6 testing and the analysis of endoscopic biopsy specimens. Written informed consent was obtained from the patient's legal guardian. The authors declare no conflict of interest.

ABSTRACTIntroductionInfectious mononucleosis (IM) and Kawasaki disease (KD) can present with overlapping clinical features, occasionally complicating the differential diagnosis. Given the significant differences in their management, accurate distinction is critical. It is exceptionally rare for a single patient to simultaneously suffer from both IM and KD in clinical practice.Case presentationWe report two cases of children over five years of age who initially presented with clinical manifestations suggestive of IM and serological evidence consistent with primary Epstein‐Barr virus (EBV) infection, supporting an initial diagnosis of IM. Subsequently, both patients developed clinical features meeting the diagnostic criteria for KD. The final diagnosis was co‐occurrence of IM and KD.ConclusionWe describe two cases of concurrent IM and KD, offering further insight into a possible association between primary EBV infection and KD. Clinicians should be mindful of the potential co‐occurrence of these disorders, strive to avoid conflicts in treatment strategies, and take proactive measures to prevent complications.

ABSTRACTImportanceHypertensive disorders in pregnancy (HDPs) are common and increase the risk of maternal and fetal morbidity and mortality. HDPs may impact fetal growth; however, sex‐specific effects have been understudied.ObjectiveTo examine whether sex‐specific differences exist in the association between HDPs and birthweight and placental weight.MethodsA birth cohort based in Detroit, Michigan, was utilized (n = 1258). HDPs and birthweight were abstracted from medical records; placental weight was obtained from placental pathology reports. Linear regression was used to model sex‐specific associations, after multiple imputation, confounder adjustment, and inverse probability weighting to account for selection bias.ResultsThe primary analysis included all pregnancies (n = 853), while the secondary analysis included those sent for placental pathology, reflective of complicated pregnancies (n = 165). In the primary analysis subset, males of mothers with gestational hypertension had birthweight Z‐scores that were on average 0.90 standard deviations higher, but this association was not found among females (interaction P = 0.019; male β [95% confidence interval {CI}]: 0.90 [0.28, 1.52]; female β [95% CI]: −0.12 [−0.65, 0.41]). However, in the subset of complicated pregnancies, female mothers with gestational hypertension also had reduced birthweight (interaction P = 0.013; male β [95% CI]: 1.50 [0.15, 2.86]; female β [95% CI]: −1.14 [−2.13, −0.16]). For fetoplacental weight ratio, any HDP was associated with a lower ratio among females only (interaction P = 0.028; male β [95% CI]: −0.04 [−0.71, 0.64]; female β [95% CI]: −0.95 [−1.57, −0.33]).InterpretationMale fetuses may prioritize growth, whereas females may prioritize placental development when exposed to HDPs.

ABSTRACTIntroductionSuprasellar cistern arachnoid cysts are rare non‐neoplastic cystic lesions that represent nearly 1% of all intracranial arachnoid cysts. Symptomatology can vary; small cysts typically do not produce any symptoms, whereas larger cysts may lead to headaches, blurred vision, and other related issues. However, the etiology, pathogenesis, and natural history of this condition remain unclear.Case presentationThis study includes four cases from our hospital from the year 2016 to 2021, first diagnosed with hydrocephalus received ventriculoperitoneal shunt treatments, the patients complicated with enlargement of the suprasellar cisterna arachnoid cyst occurred following ventriculoperitoneal shunt placement, leading to secondary obstructive hydrocephalus and received neuroendoscopic third ventriculostomy and cyst fenestration.ConclusionSuprasellar cisterna arachnoid cysts may be related to intracranial pressure dynamics. Fluctuations in intracranial pressure can lead to variations in cyst size and may result in associated symptoms. Monitoring imaging and symptoms before, during, and after surgery, along with comprehensive follow‐up, is important.

ABSTRACTDengue fever remains a significant global health threat, placing nearly half of the world's population at risk. Despite decades of research, developing an effective dengue vaccine continues to face multiple challenges, including antibody‐dependent enhancement (ADE), serotype‐specific efficacy, and logistical barriers to vaccine delivery. This review provides a comprehensive analysis of the historical and current landscape of dengue vaccine development, focusing on CYD‐TDV, TAK‐003, and Butantan‐DV. It examines their efficacy, safety profiles, and limitations, particularly in achieving balanced quadrivalent protection. Additionally, this review highlights key areas for future research, including the impact of ADE, advancements in vaccine platforms, the need for region‐specific vaccine formulations, and the integration of vaccination into broader dengue prevention strategies. Ultimately, sustained investment and global collaboration are crucial for achieving the goal of a dengue‐free world.

The incidence of juvenile-onset recurrent respiratory papillomatosis (JORRP) varies worldwide, and the lack of well-adopted guidelines for use in China suggests that patients with JORRP do not receive optimal care. In America, where data is available, pediatric patients undergo an average of 4 surgeries annually and a total of >40 surgeries in their lifetimes primarily due to this condition. It is widely accepted that timely diagnosis and implementation of scientifically sound and effective interventions can prevent JORRP progression and mitigate serious complications. Notably, evidence-based guidelines to coordinate care are lacking, and there is a need to standardize clinical practice to improve outcomes for patients. The International Pediatric Otolaryngology Group (IPOG) issued guidelines in 2020 to improve care for patients with JORRP. However, this guideline was majorly tailored to the healthcare system in Europe and America, posing a challenge to its adoption in China. To this effect, we assembled a guideline development working group to formulate guidelines for the diagnosis and treatment of JORRP tailored to the Chinese context. The working group consisting of multidisciplinary experts with experience in managing patients with JORRP undertook qualitative and quantitative studies, conducted two rounds of Delphi consensus, and carried out multiple systematic reviews/meta-analyses to provide 24 key recommendations to 12 questions of clinical interest. We anticipate that healthcare workers, including primary care physicians and specialists managing JORRP, will find the guidelines useful, and their utilization will translate to improved outcomes for patients with the disease.

Mycoplasma pneumoniae pneumonia (MPP) is the most common atypical pneumonia among children, with non-specific clinical manifestations. Despite various laboratory diagnostic methods, the diagnostic criteria remain inconsistent, potentially leading to missed or overdiagnosis. The incidence of severe and refractory cases of MPP is increasing, and there are issues with non-standard treatment in clinical practice. To standardize the diagnosis and treatment of MPP in Chinese children, the Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association, China National Clinical Research Center of Respiratory Diseases and the Editorial Board of Chinese Journal of Pediatrics jointly established a guideline expert group to formulate the "Evidence-Based Guideline for the Diagnosis and Treatment of Mycoplasma Pneumoniae Pneumonia in Children (2023)" based on both domestic and international research findings.