Objective:To investigate the clinical characteristics, imaging features, risk factors, and prognosis of childhood-onset Takayasu arteritis (TAK) with pulmonary artery involvement.Methods:A retrospective cohort study was conducted in 107 pediatric patients who were initially diagnosed with childhood-onset TAK at Department of Rheumatology and Immunology, Capital Center for Children′s Health, Capital Medical Universiy, from January 2010 to December 2024. Clinical data, including demographic information, imaging features, treatment regimens, and prognosis were collected. Patients were divided into with and without pulmonary artery involvement groups. Intergroup comparisons were performed. Multivariate logistic regression was used to identify risk factors for pulmonary artery involvement. Kaplan-Meier analysis with Log-Rank testing was used for survival analyze.Results:Among 107 children with TAK, 26 were male, 81 were female, with a diagnosis age of 88 (5, 137) months. Sixteen cases were in the pulmonary artery involvement group and 91 cases in the non-pulmonary artery involvement group. The pulmonary artery involvement group was predominantly female (14 cases), with a diagnosis age of 39 (4, 104) months. The pulmonary artery involvement group had higher incidence rates of fatigue,pulmonary hypertension, right heart failure,superior mesenteric artery involvement,as well as higher neutrophil counts, C-reactive protein (CRP) levels (all P<0.05). Hemoglobin was lower in the pulmonary artery involvement group ( P<0.05). Imaging findings revealed that all 16 children in the pulmonary artery involvement group showed signs of pulmonary arterial wall thickening. Other manifestations included dilation in 2 cases, stenosis in 2 cases, and occlusion in 1 case. Unilateral involvement (12 cases) was more common, and the right pulmonary artery (10 cases) was more frequently affected. Independent risk factors for pulmonary artery involvement in childhood-onset TAK patients included superior mesenteric artery involvement ( OR=5.58, 95% CI 1.41-22.10, P=0.014) and elevated CRP levels ( OR=1.02, 95% CI 1.00-1.03, P=0.027). During a follow-up of 3.9 (1.4,8.1) years, 2 patients with pulmonary artery involvement (all with pulmonary hypertension), among the survivors in the pulmonary artery involvement group, 2 cases still exhibited persistent pulmonary artery dilation, and one case had pulmonary artery occlusion; and 6 patients (6.6%) without pulmonary artery involvement died. Patients with pulmonary artery involvement had significantly lower survival rates compared to those without involvement ( P=0.024). Conclusions:Childhood-onset TAK with pulmonary artery involvement has an insidious clinical presentation, and can progress to pulmonary hypertension, pulmonary artery occlusion, and a significantly reduced survival rate. Patients with mesenteric artery involvement or elevated CRP have higher risks of pulmonary artery involvement, requiring close pulmonary vascular monitoring and early intervention to improve prognosis.

Objective:To investigate the clinical characteristics, imaging features, risk factors, and prognosis of childhood-onset Takayasu arteritis (TAK) with pulmonary artery involvement.Methods:A retrospective cohort study was conducted in 107 pediatric patients who were initially diagnosed with childhood-onset TAK at Department of Rheumatology and Immunology, Capital Center for Children′s Health, Capital Medical Universiy, from January 2010 to December 2024. Clinical data, including demographic information, imaging features, treatment regimens, and prognosis were collected. Patients were divided into with and without pulmonary artery involvement groups. Intergroup comparisons were performed. Multivariate logistic regression was used to identify risk factors for pulmonary artery involvement. Kaplan-Meier analysis with Log-Rank testing was used for survival analyze.Results:Among 107 children with TAK, 26 were male, 81 were female, with a diagnosis age of 88 (5, 137) months. Sixteen cases were in the pulmonary artery involvement group and 91 cases in the non-pulmonary artery involvement group. The pulmonary artery involvement group was predominantly female (14 cases), with a diagnosis age of 39 (4, 104) months. The pulmonary artery involvement group had higher incidence rates of fatigue,pulmonary hypertension, right heart failure,superior mesenteric artery involvement,as well as higher neutrophil counts, C-reactive protein (CRP) levels (all P<0.05). Hemoglobin was lower in the pulmonary artery involvement group ( P<0.05). Imaging findings revealed that all 16 children in the pulmonary artery involvement group showed signs of pulmonary arterial wall thickening. Other manifestations included dilation in 2 cases, stenosis in 2 cases, and occlusion in 1 case. Unilateral involvement (12 cases) was more common, and the right pulmonary artery (10 cases) was more frequently affected. Independent risk factors for pulmonary artery involvement in childhood-onset TAK patients included superior mesenteric artery involvement ( OR=5.58, 95% CI 1.41-22.10, P=0.014) and elevated CRP levels ( OR=1.02, 95% CI 1.00-1.03, P=0.027). During a follow-up of 3.9 (1.4,8.1) years, 2 patients with pulmonary artery involvement (all with pulmonary hypertension), among the survivors in the pulmonary artery involvement group, 2 cases still exhibited persistent pulmonary artery dilation, and one case had pulmonary artery occlusion; and 6 patients (6.6%) without pulmonary artery involvement died. Patients with pulmonary artery involvement had significantly lower survival rates compared to those without involvement ( P=0.024). Conclusions:Childhood-onset TAK with pulmonary artery involvement has an insidious clinical presentation, and can progress to pulmonary hypertension, pulmonary artery occlusion, and a significantly reduced survival rate. Patients with mesenteric artery involvement or elevated CRP have higher risks of pulmonary artery involvement, requiring close pulmonary vascular monitoring and early intervention to improve prognosis.

Complete androgen insensitivity syndrome（CAIS）is one of the most common disorders of sex development，and is an X-linked recessive disorder，mainly caused by mutations in the androgen receptor gene.The clinical manifestations are 46，XY chromosome karyotype，and female external genitalia，and the patients often presented with infantile inguinal mass and primary amenorrhea in puberty.They have endocrine features of persistent androgen resistance.Children with CAIS are mostly raised as females，and the clinical management of CAIS centers on the timing of gonadectomy，which is still controversial.Clinical guidelines recommend delaying gonadectomy until after puberty to ensure normal pubertal growth and development.Postoperative estrogen replacement therapy and psychotherapy are also important aspects of comprehensive multidisciplinary treatment.In this article，we review four aspects of CAIS：pathogenesis，clinical features，diagnosis，and treatment，in order to further improve clinicians' understanding of the disease.

Objective:To analyze the clinical characteristics of infantile Takayasu Arteritis (TAK) complicated with cardiac involvements.Methods:The clinical data and cardiac lesions of infantile TAK were collected retrospectively, and the clinical characteristics of the disease were analyzed and summarized. Mainly using decriptive statistical methods.Results:In these 20 cases, 16 cases (80%) had cardiac involvements, only 2 cases had related symptoms. The common lesions were coronary artery lesion (CAL), valvular disease, and elevated myocardial enzymes, while the rare lesions were arrhythmia, pericardial effusion, hypertensive heart disease, and heart failure. One case had acute heart failure, which was systolic heart failure and was accompanied by hypertensive heart disease. All 14 patients with CAL were found by conventional coronary ultrasound screening. A total of 39 CAL were found, all of which were coronary artery dilation, and the left main coronary artery was involved. Five patients had heart valve disease, all of them were valve insufficiency. The involved valves were mitral and tricuspid valves, and one of them was severe insufficiency. Arrhythmias were found in 2 cases, of which P1 was found to have paroxysmal atrial tachycardia with high atrioventricular block at 3 months. All 20 children survived and were in stable condition after being treat with biological agents and/or glucocorticoids. A case of hypertensive heart disease complicated with heart failure was followed up for 4 years, and the cardiac function and blood pressure returned to normal. Fourteen children with CAL lesions were given oral aspirin disease, the CALs disappeared in 10 cases and retracted in 4 cases. During the follow-up of 5 children with heart valves, insufficiency disappeared in 4 cases and improved in 1. No child underwent valve replacement during the follow-up. One of the children with arrhythmia was treated with antiarrhythmic drugs. After treatment, the arrhythmia disappeared. Now they have been followed up for 5 years without recurrence.Conclusion:Infantile TAK has a high incidence of heart involvement, with extensive lesions but insidious clinical symptoms. CALs are common, and heart failure is rare. It should be evaluated and treated as early as possible.

Objective:To investigate the clinical features, treatment and follow-up of children with early-onset antinuclear antibody (ANA)-positive juvenile idiopathic arthritis (JIA).Methods:Eighty-six oligoarticular JIA patients with early-onset arthritis (≤6 years old) admitted to the Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2017 to December 2019 were included in this study. According to ANA titer, these patients were divided into two groups: ANA-positive group (44 cases) and ANA-negative group (42 cases). Clinical data including demographic data, clinical features, laboratory testing results, treatment and follow-up data were statistically analyzed.Results:The ratio of male to female was 7∶37 in the ANA-positive group and 15∶27 in the ANA-negative group and there was significant difference between the two groups ( P=0.035). The proportions of patients with increased C-reactive protein and erythrocyte sedimentation rate were higher in the ANA-positive group than in the ANA-negative group [18.18% (8/44) vs 16.67% (7/42) and 29.55% (13/44) vs 19.05% (8/42), both P>0.05]. The most commonly involved joints in the ANA-positive group were knee (95.45%, 42/44), ankle (20.45%, 9/44) and wrist (18.18%, 8/44), and unilateral asymmetric joint involvement accounted for 81.8% (36/44). In the ANA-negative group, the involved joints were knee (85.71%, 36/42), ankle (14.29%, 6/42), wrist (14.29%, 6/42) and hip (11.90%, 5/42), and 27 out of the 42 cases (64.29%) had unilateral asymmetric joint involvement. There was no significant difference in the above indexes between the two groups (all P>0.05). There were seven cases (15.91%) with uveitis in the ANA-positive group and two cases (4.76%) in the ANA-negative group, and the difference between the two groups was significant ( P=0.045). Before treatment, the ANA-positive group had a significantly higher disease activity score (JADAS27) than the ANA-negative group (14.43±2.87 vs 12.09±3.32, P=0.002). After treatment, the JADAS27 score in both groups decreased (both P<0.05). After six months of treatment, the two groups had similar clinical remission rates [70.45% (31/44) vs 76.19% (32/42), P>0.05]. Conclusions:Early-onset ANA-positive JIA was more common in female children, and asymmetric knee joint involvement was the most common clinical manifestation. The incidence of ophthalmic complications was high, and ophthalmological examination should be performed more frequently during follow-up. The prognosis of early-onset ANA-positive JIA was good with early treatment. Positive ANA was not a risk factor for poor prognosis.

Objective:To observe the clinical efficacy of intra-articular injection with Triamcinolone acetonide on the treatment of juvenile idiopathic arthritis (JIA).Methods:The clinical data of 26 children diagnosed with JIA undergoing the intra-articular injection of Triamcinolone acetonide for the joints with obvious swelling and pain at the Children′s Hospital Affiliated to Capital Institute of Pediatrics from October 2018 to December 2019 who were retrospectively analyzed.Erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) were tested before and after the application of Triamcinolone acetonide.Detailed clinical manifestations were recorded.The nonparametric Kruskal- Wallis test was used to compare the differences in clinical evaluation indicators and changes in laboratory tests at diffe-rent treatment times. Results:Among the 26 children, 8 were boys and 18 were girls.After the intra-articular injection of Triamcinolone acetonide, 9 cases (34.62%) achieved complete remission, 15 cases(57.69%) achieved partial remission, and 2 cases (7.69%) were not responsive to the intra-articular injection.The overall therapeutic efficacy was 92.31%.Compared with pre-treatment period, from 4 weeks after treatment, assessment of disease activity by the physicians and parents of the children was significantly improved after 4-week treatment, and the number of active joints, ESR and CRP and the Juvenile Arthritis Disease Activity Score with 27 joints (JADAS 27) gradually decreased, and the differences were statistically significant (all P<0.05). No adverse drug reactions were seen during the treatment and follow-up period. Conclusions:Intra-articular injection of Triamcinolone acetonide is effective in contro-lling joint symptoms of JIA with less adverse events.

Objective:To summarize the clinical features of chronic non-bacterial osteomyelitis (CNO) in children.Methods:Clinical data of 8 CNO patients admitted to the Department of Rheumatology and Immunology, Children′s Hospital Affiliated to Capital Institute of Pediatrics from March 2014 to December 2020 were retrospectively analyzed.The clinical characteristics of 8 children with CNO were summarized and compared with those reported abroad.Results:A total of 8 CNO patients were recruited, involving 3 males and 5 females with the mean age of onset (7.2±3.2)years, and the average diagnosis time 25.9 months, respectively.The common clinical symptoms included bone pain (7 cases, 87.5%), arthritis (4 cases, 50.0%), and fever (3 cases, 37.5%). The main manifestations on X-ray and CT scans were bone destruction and progressive osteosclerosis.Magnetic resonance imaging (MRI) showed bone marrow edema, periostitis, soft tissue swelling, and enhancement.All of them had more than one site of bone involvement.Seven patients(87.5%) had bilateral bone involvement, with the most common site of tibia (22.0%), followed by femur (17.1%) and mandible (9.8%). Bone biopsy was performed in 8 patients, and 4 cases showed osteonecrosis, 4 cases showed bone fibrosis and 2 cases showed osteomyelitis.The etiological examination of the bone was negative.Eight children received non-steroid anti-inflammatory drugs alone or in combination with glucocorticoids, disease-modifying antirheumatic drugs (DMARDs), bisphosphonates or tumor necrosis factor-α(TNF-α) antagonists.After treatment, the patients were followed up for 3 months to 2 years.Eight children improved.Their inflammatory indexes were normal, and had no disability, teratology or multiple organ damage.Conclusions:Pediatric CNO is more common in children of school age, with a long course of disease.The main manifestations are multi-site bone pain and arthritis.Imaging studies indicate multiple bone involvement, which is more common at lower extremities.Non-steroids anti-inflammatory drugs, glucocorticoids, DMARDs, bisphosphonates and TNF-α antagonists are effective to CNO.

Objective:To investigate the changes of thyroid hormone level in children with type 1 diabetic mellitus (T1DM) complicated with ketoacidosis.Methods:Sixty-seven children with acute T1DM and ketoacidosis admitted in Department of Endocrinology, Shanxi Children′s Hospital from December 2017 to December 2020 were enrolled as acidosis group; and 44 T1DM children without ketoacidosis at admission served as control group. According to blood gas analysis, in acidosis patients there were 22 cases in mild group (pH<7.3), 16 cases in moderate group (pH<7.2) and 29 cases in severe group (pH<7.1). Serum levels of triiodothyronine (T 3), thyroxine (T 4), free T 3(FT 3), free T 4(FT 4), thyroid stimulating hormone (TSH) were measured in all patients at admission and recovery, retrospectively. Patients in the acidosis group at acute stage were treated with balanced fluid infusion, insulin infusion and eritone. Results:The serum levels of T 3 [0.48(0.19, 0.67)nmol/L vs. 0.97(0.74, 1.18)nmol/L, Z=-5.97, P<0.001], T 4 [(49.99±26.06) nmol/L vs. (73.48±23.32)nmol/L, t=4.68, P<0.001], FT 3 [1.80(1.24, 2.51) pmol/L vs. 3.31(2.56, 3.98) pmol/L, Z=-6.15, P<0.001], FT 4 [9.74 (7.21, 12.85)pmol/L vs. 14.54 (11.29, 16.75)pmol/L, Z=-5.23, P<0.001] and TSH [0.86(0.31, 1.81) mIU/L vs. 1.92(1.01, 3.56)mIU/L, Z=-4.19, P<0.001] in acidosis group at acute stage were significantly lower than those in the control group. In acidosis group at recovery stage serum levels of T 3 [1.58 (1.25, 1.86)nmol/L], T 4 [(92.52±27.03) nmol/L], FT 3 [5.03(4.15, 5.78) pmol/L], FT 4 [15.94 (14.40, 18.38)pmol/L], and TSH [2.21(1.58, 3.16)mIU/L] were significantly higher than those at acute stage ( Z=-6.96, t=-11.34, Z=-7.00, Z=-6.39, Z=-5.28,all P<0.001). There was an decreasing trend of T 3 and FT 3 levels from mild group [0.60 (0.47, 0.78)nmol/L, 2.20(1.47, 2.89) pmol/L], moderate group [0.36(0.18, 0.64)nmol/L, 1.90(1.11, 2.31)pmol/L] to severe acidosis group [0.35(0.16, 0.54) nmol/L, 1.48(1.08, 1.89)pmol/L](T 3: Z=-3.44, P=0.001; Z=-3.97, P<0.001; Z=-5.63, P<0.001;FT 3: Z=-3.44, P=0.001; Z=-4.13, P<0.001; Z=-5.86, P<0.001). Compared to control group serum T 4 and FT 4 levels in moderate group [(47.34±29.89)nmol/L and 9.75(5.74,12.29)pmol/L] and severe group [(44.08±22.27)nmol/L and 8.82 (6.40, 9.89)pmol/L] were significantly decreased (T 4: t=3.66, t=5.01,all P<0.001; FT 4: Z=-3.40, P=0.001; Z=-5.73, P<0.001). The TSH level in severe acidosis group [0.63 (0.27, 1.33)mIU/L] was lower than that in the control group ( Z=-4.23, P<0.001). At the recovery stage the serum levels of T 3 [1.69 (1.22, 1.87)nmol/L,1.68 (1.24, 1.84)nmol/L,1.55(1.25, 1.86) nmol/L], FT 3 [5.27 (4.37, 5.76)pmol/L,4.32(4.17, 5.73)pmol/L,5.04(3.81, 5.79)pmol/L], T 4 [(87.41±18.40)nmol/L,(90.02±30.41)nmol/L,(97.34±30.10)nmol/L] and FT 4 [16.05(14.23, 17.71) pmol/L,15.26(14.40, 16.11)pmol/L,16.88(13.98, 18.89) pmol/L] in the mild, moderate and severe acidosis groups were higher than those in the control group (T 3: Z=-4.55, Z=-3.87, Z=-4.93,all P<0.001;FT 3: Z=-4.72, Z=-3.72, Z=-4.52,all P<0.001;T 4: t=-2.01, P=0.047; t=-2.15, P=0.034; t=-3.88, P<0.001;FT 4: Z=-2.21, P=0.027; Z=-0.84, P=0.399; Z=-2.67, P=0.008); while there was no significant difference in TSH levels [2.28(1.88, 3.16)mIU/L, 2.19(1.26, 3.57) mIU/L, 2.18(1.36, 3.09) mIU/L] between mild, moderate, severe acidosis groups and the control group (all P>0.05). Conclusions:Thyroid function in T1DM children complicated with ketoacidosis is decreased significantly with the aggravation of acidosis. After correction of ketoacidosis, the level of thyroid function can basically return to normal.

Objective:To investigate the clinical features, diagnosis and treatment of systemic juvenile idiopathic arthritis (SJIA) complicated with macrophage activation syndrome (MAS).Methods:From January 1st, 2018 to January 1st, 2020, 7 cases of SJIA-MAS were diagnosed. Their clinical and laboratory data were collected and summarized.Results:In these 7 cases, 2 were males and 5 were females, the ratio of male to female was 2∶5. The age range was 11 months to 2 years old. The course of disease was 14 to 32 days. The clinical manifestations included fever and rash in 7 without arthritis; hepatomegaly, splenomegaly and lymphadenopathy in 7; hematological involvement in 7; nervous system involvement in 2; digestive system involvement in 7; respiratory system involvement in 7; cardiovascular involvement in 3. White blood cell was decreased in 1 case, platelet was decreased in 1 case and hemoglobin was decreased in 7 cases. Ferritin, triglyceride, alanine transaminas and aspartate aminotransferase were increased in 7 cases, fibrinogen was significantly decreased in 7 cases, and direct bilirubin was increased in 4 cases. IL-2R was significantly increased. Hemophagocytosis was observed in bone marrow of 4 cases. Cerebrospinal fluid protein was 2 005 mg/L in 1 case. All the 7 cases were tested for exon genes, and no pathogenic mutation was found. All of the 7 cases showed lung lesions in chest CT scan. Multiple demyelinating lesions were found in 1 case by head magnetic resonance imaging. One case was treated with high-dose intravenous methylprednisolone combined with IL-6 receptor antagonist(tocilizumab). The other 6 cases were treated with high-dose intravenous methylprednisolone combined with cyclosporine A (CsA). Two cases were treated with Janus kinases inhibitor(tofacitinib). After treatment, 7 cases got relieved, no death, no recurrence oocurred during the follow-up.Conclusion:Acute onset, multiple organ involvement and no joint inflammation are prominent in MAS of infants and toddlers. High fever, proressive reduction of blood cells and increase of SF are significant in SJIA-MAS. High dose glucocorticoid combined with CsA can benefit in most cases, and some severe cases need to be treated with biological agents.

Objective: To improve the understanding and diagnosis and treatment level of infant with Takayasu arteritis (TA) by analyzing the clinical features of 14 pediatric patients and reviewing related articles. Methods: The clinical and follow-up data of infants with TA who were admitted to the Children′s Hospital Affiliated to Capital Institute of Pediatrics between July 2016 and May 2019 were retrospectively analyzed.By reviewing related articles, the clinical features of this disease were summarized. Results: The age of 14 patients (including 6 males and 8 females) were between 1 month and 23 days and 28 months.The most common clinical manifestations were fever in 10 cases (71.4%), hypertension in 9 cases (64.3%), weak or no pulse in 5 cases (35.7%). According to the clinical type of lesion vessels, 11 cases (78.5%) were generalized type, 3 cases (21.4%) were brachiocephalic artery type, and there was no thoracic abdominal aorta or single pulmonary artery type in this group.Among 14 infants with TA, 12 cases had common carotid artery, carotid artery, subclavian artery, coronary artery and its branches (anterior descending branch, circumflex branch) involved (85.7%); 11 cases had renal artery involved (78.6%); 9 cases had radial artery involved (64.2%); 8 cases had abdominal aorta involved (57.1%); 6 cases had descending aorta involved (42.9%); 6 cases had thoracic aorta involved (42.9%); 6 cases had superior mesenteric artery involved (42.9%); 5 cases had femoral artery involved (35.7%); 5 cases had pulmonary artery involved (35.7%); and 4 cases had brachial artery involved (28.6%). In those 14 patients, 11 cases were misdiagnosed, and 3 cases had unclear diagnosis, with misdiagnosis duration of 18 days to 2 months.In misdiagnosed cases, 8 cases were misdiagnosed as atypical Kawasaki disease.Among those 14 cases, the ranges of most lesions were gradually decreased, and the slightly involved vessels even completely returned to normal state after treatment in 7 cases.The vascular imaging showed no significant exacerbation or improvement in 4 cases.Nine cases developed hypertension, the blood pressure of whom could be controlled within normal range with hypotensive drugs which could not be interrupted.Physical examination found weak or no pulse in 5 cases who were not improved.Among 14 patients, 7 cases showed normal development, while the height and body mass of another 7 cases were the 25^th percentile below those of normal children of the same age.All 14 patients were followed up for 2-22 months and received regular treatment without recurrence. Conclusions TA patients aged less than 3 years tend to have more blood vessels involved, be in serious condition and have higher rate of misdiagnosis.The disease can be controlled quickly after treatment, but vascular diseases may be developed easily.Some patients have a poor prognosis.