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The World Health Organization's (WHO's) new focus on rehabilitation offers great opportunities for occupational therapy. Recognizing that the problems in daily function created by the aging of the world's population and the increasing prevalence of chronic health conditions require rehabilitation to be a vital part of health systems, the World Health Organization brought a variety of stakeholders together in 2017 and 2019 to help them develop the Rehabilitation 2030 initiative. Occupational therapy was represented by the World Federation of Occupational Therapists, the American Journal of Occupational Therapy, the Canadian Journal of Occupational Therapy, editorial board members of several occupational therapy journals, and other occupational therapy researchers. A major challenge to meeting the goal of sufficient rehabilitation services to meet global need is the worldwide shortage of occupational therapists. This shortage can be attributed to a paucity of knowledge about occupational therapy as a health care profession, lack of understanding of the occupational therapy scope of practice, the cost of education required to become an occupational therapist, and the need for occupational therapy salaries to offset educational costs. Nonetheless, ongoing success in research and clinical outcomes will increase knowledge of the value of occupational therapy and increase the size of the profession. WHO's focus on function is to be lauded. Yet, occupational therapists must not be content with an emphasis on function. They also need to advocate for contextual changes that eliminate barriers to participation and engagement experienced by people with disability. Copyright © 2020 by the American Occupational Therapy Association, Inc.Hyperbilirubinemia is a prevalent disease in neonates and is also a main reason for hospitalization within the first week after birth, and this disease is mainly caused by the imbalance between production and elimination of bilirubin. Uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1), organic anion transporter polypeptide 2 (OATP2), heme oxygenase 1 (HO-1), and biliverdin reductase A (BLVRA) play crucial roles in the metabolism of bilirubin. More and more studies have revealed the association between the variation of the encoding genes for these enzymes and hyperbilirubinemia. This article reviews the research advances in the association between the gene polymorphisms of bilirubin metabolic enzymes and hyperbilirubinemia.A boy, aged 4 months, had the major clinical manifestations of prolonged jaundice and hepatomegaly. Multiple biochemical tests revealed abnormal liver function along with elevated alpha-fetoprotein and lactate. Genetic analysis confirmed that the boy had the mutations of c.589C>T(p.Gln197Ter) and c.687G>C(p.Trp229Cys) in the DGUOK gene, both of which were novel mutations and were determined to be pathogenic and likely pathogenic respectively, by a variety of bioinformatics tools and the ACMG standard. Therefore, the boy was confirmed to have DGUOK-related mitochondrial DNA depletion syndrome. Literature review showed that onset of liver disease in infancy was the main clinical feature of this disease, and some children presented with nervous system manifestations. Abnormal laboratory results included abnormal liver function, increases in blood lactate, serum ferritin and alpha-fetoprotein, and hypoglycemia. Such children had marked heterogeneity of DGUOK gene mutations, with missense mutations as the most common type. This disease tended to have a poor prognosis, and 79.6% of the children died before the age of 3 years.OBJECTIVE To study the value of serum miR-21-3p combined with serum creatinine (Scr), cystatin C (Cys-C), and kidney injury molecule-1 (KIM-1) in predicting acute kidney injury (AKI) in children with sepsis. METHODS A total of 142 children who were diagnosed with sepsis from January 2016 to March 2019 were enrolled. According to the presence or absence of AKI, they were divided into AKI group with 49 children and non-AKI group with 93 children. The serum levels of miR-21-3p, Scr, Cys-C, and KIM-1 were measured for the two groups. The receiver operating characteristic (ROC) curve was plotted to analyze the value of serum miR-21-3p, Scr, Cys-C, and KIM-1 in predicting AKI. A Pearson correlation analysis was used to evaluate the correlation of serum miR-21-3p with Scr, Cys-C, and KIM-1. RESULTS The AKI group had significantly higher serum levels of miR-21-3p, Scr, Cys-C, and KIM-1 than the non-AKI group (P less then 0.05). The ROC curve analysis showed that the combination of serum miR-21-3p, Scr, Cys-C, and KIM-1 had an area under the ROC curve (AUC) of 0.962 (95%CI 0.906-0.998), which was significantly larger than the AUC of each index alone (P less then 0.05), with a sensitivity of 97.0% and a specificity of 91.4%. The correlation analysis showed that the serum level of miR-21-3p was positively correlated with Scr, Cys-C, and KIM-1 in the AKI group (r=0.704, 0.812, and 0.863 respectively, P less then 0.01). CONCLUSIONS There is a significant increase in the serum level of miR-21-3p in children with sepsis and AKI, and its combination with Scr, Cys-C, and KIM-1 has a high value in predicting AKI.OBJECTIVE To study the differentially expressed mRNAs between MYCN-amplified neuroblastoma (NB) and non-amplified NB, to screen out the genes which can be used to predict the prognosis of MYCN-amplified NB, and to analyze their value in predicting prognosis. METHODS NB transcriptome data and the clinical data of children were obtained from the TARGET database. According to the presence or absence of MYCN amplification, the children were divided into two groups MYCN amplification (n=33) and non-MYCN amplification (n=121). The expression of mRNAs was compared between the two groups to obtain differentially expressed genes (DEGs). OPC-67683 Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) analysis was performed to investigate the main functions of DEGs. The Cox proportional-hazards regression model analysis was used to investigate the genes influencing the prognosis of MYCN-amplified NB. The children were divided into a high-risk group (n=77) and a low-risk group (n=77) based on the median of risk scorcurve of 0.729, an optimal cut-off value of 1.316, a sensitivity of 53.2%, and a specificity of 84.4%. CONCLUSIONS The mRNA expression of FLVCR2, SCN7A, PRSS12, NTRK1, and XAGE1A genes can be used as biomarkers to predict the prognosis of MYCN-amplified NB, which can help to refine clinical risk stratification.OBJECTIVE To study the clinical features of neuroendocrine cell hyperplasia of infancy (NEHI) in order to provide a basis for the management of diagnosis, treatment and prognosis of children with NEHI. METHODS A retrospective analysis was performed for the clinical data of seven children with NEHI who were diagnosed and treated from January 2014 to March 2016. RESULTS Among the seven children with NEHI, there were five boys and two girls. Two children experienced tachypnea since the neonatal period, and five children developed respiratory tract symptoms within 1-6 months after birth. Of the 7 children, 6 had pulmonary crackles, 4 had hypoxemia, and 3 had gastroesophageal reflux. Lung high-resolution CT (HRCT) showed ground-glass opacities in the central region of the lungs in all children, which involved at least two lung lobes. Of the 7 children, 2 had the involvement of more than 4 lobes and 6 had air trapping. All 7 children had an improvement in clinical symptoms after two years of age. One child achieved clinical and CT remission. Four children achieved clinical remission, but still with CT changes. CONCLUSIONS NEHI often occurs in infancy, with the major clinical manifestations of persistent tachypnea, pulmonary crackles, and hypoxemia. The children with NEHI often present ground-glass opacities in the central region of the lungs and air trapping on HRCT. There is no specific treatment for this disease and most cases have a good prognosis.OBJECTIVE To study the association between CD40-CD40L system and obesity in children. METHODS A total of 76 obese children were enrolled as the obese group, and 74 healthy children with normal body mass index (BMI) were enrolled as the control group. The two groups were compared in terms of morphological indices, biochemical parameters, and serum levels of CD40 and CD40L. Partial correlation analysis and multivariate linear regression analysis were performed to investigate the correlation of CD40 and CD40L with other clinical indices. RESULTS Compared with the control group, the obese group had significantly higher BMI, waist circumference/height ratio, systolic pressure, diastolic pressure, alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, triglyceride, apolipoprotein B, fasting blood glucose, fasting insulin, glycosylated hemoglobin, platelet count, CD40L, and mean carotid intima-media thickness (P less then 0.05), but significantly lower high-density lipoprotein cholesterol and apolipoprotein A1 (P less then 0.05). With age and sex as the control factors, the partial correlation analysis showed that CD40L was positively correlated with height, weight, BMI, diastolic pressure, bile acid, triglyceride, total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and platelet count (P less then 0.05). CD40 was positively correlated with waist circumference/height ratio and platelet count (P less then 0.05). The multivariate linear regression analysis showed that ALT, AST, total cholesterol, and platelet count were the dependent factors influencing the level of CD40L (R2=0.266, P less then 0.05). CONCLUSIONS CD40-CD40L system is closely associated with obesity and related hyperlipidemia and hypertension. CD40 and CD40L may be used as new indicators for early warning of metabolic syndrome and provide new ideas for the prevention and treatment of related chronic diseases.OBJECTIVE To systematically review the effect of sustained lung inflation (SLI) in preterm infants with a gestational age of 0.05). CONCLUSIONS SLI can reduce the use of mechanical ventilation in preterm infants with a gestational age of less then 34 weeks and does not increase the risk of other complications.OBJECTIVE To study the association between maternal age and adverse pregnancy outcome in twin pregnancy. METHODS The clinical data of 2 363 women with twin pregnancy from January 2006 to June 2016 were retrospectively reviewed. According to the age, the women were divided into six groups less then 20 years (n=15), 20-24 years (n=158), 25-29 years (n=894), 30-34 years (n=936), 35-39 years (n=320), and ≥40 years group (n=40). The above groups were compared in terms of related baseline features and incidence rates of adverse pregnancy outcomes (preterm birth, birth defect, stillbirth in late pregnancy and small-for-gestational-age birth). A generalized estimating equation was used to investigate the risk of adverse pregnancy outcomes in different age groups. RESULTS After control for the factors including place of residence, primipara, pregnancy pattern, and gestational diseases, the incidence rates of very preterm birth and moderately preterm birth in the ≥40 years group were 2.60 and 1.99 times than those in the 25-29 years group respectively (P less then 0.
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