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BackgroundAsthma represents a significant global health challenge, exhibiting considerable variation in prevalence, incidence, mortality and disability-adjusted life years (DALYs) across regions and countries. This study evaluates global, regional and national trends in asthma burden from 1990 to 2021, analysing associations with temporal, geographical and demographical factors.MethodsUsing open data from the Global Burden of Disease (GBD) database (1990–2021), we analysed changes in asthma prevalence, incidence, mortality and DALYs by gender, age and Socio-Demographic Index (SDI) groups. Joinpoint regression analysis calculated the average annual percentage change (AAPC) and annual percentage change (APC).ResultsFrom 1990 to 2021, the age-standardised prevalence and incidence rates of asthma declined by 40.01% and 29.89%, respectively. While asthma deaths increased slightly, the age-standardised mortality rate (ASMR) declined by 46.01%. The highest prevalence was observed in South Asia, East Asia and high-income North America, while low-SDI regions exhibited elevated mortality and DALYs. The age and sex-specific patterns indicated a higher asthma burden among females. The results of the joinpoint analysis indicated a global age-standardised incidence rate increase between 2005 and 2010 for both males and females. The ASMR exhibited a statistically significant decline from 1990 to 2021.ConclusionsThe global age-standardised rate of asthma burden declined from 1990 to 2021. However, asthma remains a significant public health issue, particularly in regions with lower socioeconomic development. Understanding global and regional trends in asthma can inform future policies and interventions, aiming to promote more equitable prevention, diagnosis and treatment worldwide.

Lung consolidation (LC) in pediatric pneumonia could lead to complicated clinical outcomes, yet the underlying immunological mechanisms are not fully understood. This study aimed to investigate the roles of local and systemic cytokines in the development of pulmonary complications and disease progression in children with pneumonia-associated LC. Conducted at the Shanghai Children's Medical Center, this study included 169 children admitted between June 2022 and October 2023. We analyzed levels of fifteen cytokines in bronchoalveolar lavage fluid (BALF) and blood. Classification and regression tree (CART) analysis identified specific cytokines associated with pulmonary complications and hypoxemia. In children with LC, most local cytokines were found at higher levels than systemic cytokines, with no apparent correlation between the two. Notably, an elevated level of IL-8 (≥ 6615 pg/ml) in BALF was associated with an increased risk of hypoxemia. Additionally, elevated levels of IL-4 and INF-γ in BALF were closely associated with the development of multi-segmental LC. Furthermore, elevated levels of IL-2R in BALF were significantly associated with the occurrence of atelectasis, in contrast to their levels in peripheral blood. IL-4, INF-γ, IL-2R, and IL-8 levels in BALF are closely associated with pulmonary complications and disease progression in children with LC. Exploring targeted immunomodulatory therapies in these children may mitigate lung injury caused by excessive local inflammatory responses.

Objective: To estimate the clinical effectiveness of oseltamivir in children with different subtypes of influenza virus infection. Methods: A total of 998 children with acute respiratory infection were enrolled from January to March 2018, and were divided into influenza A, influenza B, influenza A + B, and non-influenza infection (IV-negative) groups. Influenza-like symptoms and duration of fever were evaluated and compared between oseltamivir-treated and non-treated groups. Results: There were no significant differences in the reduction in total febrile period and duration of fever from the onset of therapy between the oseltamivir treated and non-treated children infected with influenza A ( p = 0.6885 for total febrile period and 0.7904 for the duration of fever from the onset of treatment), influenza B ( p = 0.1462 and 0.1966), influenza A + B ( p = 0.5568 and 0.9320), and IV-negative ( p = 0.7631 and 0.4655). The duration of fever in children received oseltamivir therapy within 48 h was not significantly shorter than that beyond 48 h ( p > 0.05). Additionally, percentages and severities of influenza-like symptoms, including headache, myalgia, fatigue, bellyache, vomiting, diarrhea, sore throat, cough, and coryza were not decreased and alleviated after treatment of oseltamivir. Conclusion: Oseltamivir treatment does not significantly shorten the duration of fever, nor does it significantly relieve influenza-like symptoms in children with infection of influenza.

Background There are few studies on the changes in lung function after pneumonia in children. This study aims to explore the changes in lung function in children after pneumonia and analyze the risk factors for airway disorder, especially the impact of different pathogen infection on lung function. Methods This study collected data from patients who were hospitalized due to pneumonia in ten Chinese hospitals between January 2023 and December 2024. Pulmonary function tests were performed to assess changes in lung function one week and one month after discharge. Results A total of 566 children were included in this study, with 40.6% of patients still showing airway disorder one week after discharge. Different pathogenic infections had varying effects on pulmonary function. MP (Mycoplasma pneumoniae) infection [OR (95%CI): 1.881(1.268–2.789), P  = 0.001] and RhV (rhinovirus) infection [OR (95%CI): 2.402(1.027–5.621), P  = 0.043] were significant risk factors for the occurrence of SAD (Small Airway Disorder) one week after discharge. Male gender [OR (95%CI): 2.219, P  = 0.001] and MP infection [OR (95%CI): 1.681(1.024–2.761), P  = 0.039] were significant risk factors for the occurrence of LAD (Large Airway Disorder) one week after discharge. No positive pathogen results [OR (95%CI): 0.366(0.168–0.800), P  = 0.011] were significant protective factors for the persistence of SAD one month after discharge, while RhV infection [OR (95%CI): 7.286(0.802, 66.238), P  = 0.077] and lung consolidation [OR (95%CI): 1.753(0.956, 3.214), P  = 0.069] showed mild significance for the persistence of SAD one month after discharge. Male gender [OR (95%CI): 2.246(1.137–4.436), P  = 0.019] and RhV infection [OR (95%CI): 1.967(1.630–237.549), P  = 0.019] were significant risk factors for the persistence of LAD one month after discharge, while no positive pathogen results [OR (95%CI): 0.249(0.092–0.678), P  = 0.006] were a significant protective factor. Conclusions Approximately 40.6% of children after pneumonia still had airway disorder one week after discharge, which was closely related to different pathogenic infections. Patients with RhV pneumonia, in particular, should be closely monitored for changes in lung function after discharge.

The relationship between allergic diseases and the adverse outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been a subject of controversy. This study aimed to investigate the association between allergic diseases and the incidence and severity of symptoms in SARS-CoV-2 infection. Clinical data of individuals, including children and their parents, infected with SARS-CoV-2 from December 2022 to January 2023 in China were retrospectively analyzed. The data were collected through questionnaires. Statistical analysis, including chi-squared tests, nonparametric analysis, one-way ANOVA, and logistic regression analysis, was used to examine the relationship between allergic diseases, prior medication, and the symptoms of SARS-CoV-2 infection. There were 3,517 adults and 3,372 children with SARS-CoV-2 infection included in the study. Fever was found to occur at similar rates in children (86.5%) and adults (86.8%). However, other symptoms related to respiratory issues (such as cough and sore throat), neurological symptoms (headache, loss of smell, and loss of taste), and systemic symptoms (muscle soreness and weakness) were observed more frequently in adults ( < 0.001). Additionally, adults exhibited higher overall symptom scores, indicating greater severity. Allergic diseases were found to be associated with the incidence of certain SARS-CoV-2 infection symptoms in both children and adults. Specifically, children with allergic rhinitis (AR) were observed to be more susceptible to upper respiratory symptoms (OR: 1.320, 95% CI: 1.081-1.611, = 0.006), while asthma patients were found to be more susceptible to severe respiratory symptoms (OR: 1.736, 95% CI: 1.250-2.411, = 0.001). Similar patterns were identified in adults. Furthermore, AR was also suggested to be a risk factor for symptom severity in both children (OR: 1.704, 95% CI: 1.314-2.209, < 0.001) and adults (OR: 1.736, 95% CI: 1.250-2.411, = 0.001). However, prior medication for allergic diseases did not exhibit a preventive effect on SARS-CoV-2 infection symptoms. Both children and adults with allergic diseases were found to be more prone to experiencing symptoms of SARS-CoV-2 infection, and these symptoms tended to be more severe.

Pediatric fever is a prevalent concern, often causing parental anxiety and frequent medical consultations. While large language models (LLMs) such as ChatGPT, Perplexity, and YouChat show promise in enhancing medical communication and education, their efficacy in addressing complex pediatric fever-related questions remains underexplored, particularly from the perspectives of medical professionals and patients' relatives. This study aimed to explore the differences and similarities among four common large language models (ChatGPT3.5, ChatGPT4.0, YouChat, and Perplexity) in answering thirty pediatric fever-related questions and to examine how doctors and pediatric patients' relatives evaluate the LLM-generated answers based on predefined criteria. The study selected thirty fever-related pediatric questions answered by the four models. Twenty doctors rated these responses across four dimensions. To conduct the survey among pediatric patients' relatives, we eliminated certain responses that we deemed to pose safety risks or be misleading. Based on the doctors' questionnaire, the thirty questions were divided into six groups, each evaluated by twenty pediatric relatives. The Tukey test was used to check for significant differences. Some of pediatric relatives was revisited for deeper insights into the results. In the doctors' questionnaire, ChatGPT3.5 and ChatGPT4.0 outperformed YouChat and Perplexity in all dimensions, with no significant difference between ChatGPT3.5 and ChatGPT4.0 or between YouChat and Perplexity. All models scored significantly better in accuracy than other dimensions. In the pediatric relatives' questionnaire, no significant differences were found among the models, with revisits revealing some reasons for these results. Internet searches (YouChat and Perplexity) did not improve the ability of large language models to answer medical questions as expected. Patients lacked the ability to understand and analyze model responses due to a lack of professional knowledge and a lack of central points in model answers. When developing large language models for patient use, it's important to highlight the central points of the answers and ensure they are easily understandable.

Background: Since late February 2022, a wave of coronavirus disease 2019 (COVID-19) mainly caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant rapidly appeared in Shanghai, China. Traditional Chinese medicine treatment is recommended for pediatric patients; however, the safety and efficacy remain to be confirmed. We conducted a single-center, open-label, parallel-group randomized controlled trial to assess the efficacy and safety of a Chinese herb compound, Huashi Baidu granule (HSBDG) in pediatric patients with laboratory-confirmed mild COVID-19. Methods: 108 recruited children (aged 3–18 years) with laboratory-confirmed mild COVID-19 were randomly allocated 2:1 to receive oral HSBDG for five consecutive days (intervention group) and to receive compound pholcodine oral solution for five consecutive days (control group). The negative conversion time of SARS-CoV-2 nucleic acid and symptom scores were recorded. Results: The median negative conversion time of SARS-CoV-2 nucleic acid was significantly shorter in the intervention group than in the control group (median days [interquartile range (IQR)]: 3 [3–5] vs. 5 [3–6]; p = 0.047). The median total symptom score on day 3 was significantly lower in the intervention group than in the control group (median total symptom score [IQR]: 1 [0–2] vs. 2 [0–3]; p = 0.036). There was no significant differences in the frequency of antibiotic use and side effects between the two groups. Conclusion: HSBDG is a safe, effective oral Chinese herbal compound granule, which shows a good performance within the Omicron wave among pediatric patients.

This study aimed to assess the associations of caesarean delivery (CD) with risk of wheezing diseases and changes of immune cells in children. The cross-sectional study was conducted between May, 2020 and April, 2021. The study was conducted in Shanghai Children's Medical Center, Shanghai, China. A total of 2079 children with a mean age of 36.97 ± 40.27 months and their guardians were included in the present study face-to-face inquiry and physical examination by clinicians. Logistic regression was applied to estimate odds ratio (ORs) and 95% confidence intervals (CIs) for the association between CD and first episode of wheezing (FEW) or asthma. Models were adjusted for premature or full-term delivery, exclusive breastfeeding (at least 4 months) or not. Among the 2079 children, 987 children (47.47%) were born by CD and 1092 (52.53%) by vaginal delivery (VD). Children delivered by caesarean had significantly lower gestational age (P<0.01) compared with those who delivered vaginally. Our results also showed that CD was related to increased risk of FEW by the age of 3(adjusted OR 1.50, 95%CI 1.06, 2.12) and increased tendency to develop asthma by the age of 4 (adjusted OR 3.16, 95%CI 1.25, 9.01). The subgroup analysis revealed that the negative effects of CD on asthma were more obvious in children without exclusive breastfeeding (adjusted OR 4.93, 95%CI 1.53, 21.96) or without postnatal smoking exposure (adjusted OR 3.58, 95%CI 1.20, 13.13). Furthermore, compared with children born through VD, a significant change of the T cells (increased proportion of CD4+ T cells and decreased number and proportion of CD8+ T cells) were observed before the age of one in the CD group. However, the changes were insignificant in children over 1 year old. This study showed age-dependent associations of CD with asthma and FEW in offspring. Moreover, CD appeared to have an effect on the cellular immunity in infants, the disorder of which may contribute to the development of asthma in children.

ObjectivesTo review the effects and safety of high-flow nasal cannula (HFNC) for bronchiolitis.MethodsSix electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, CQ VIP Database and Wanfang Data were searched from their inception to 1 June 2018. Randomised controlled trials (RCTs) which investigated the effects of HFNC versus other forms of oxygen therapies for bronchiolitis were included.ResultsNine RCTs with 2121 children met the eligibility criteria. There was no significant difference in length of stay in hospital (LOS), length of oxygen supplementation (LOO), transfer to intensive care unit, incidence of intubation, respiratory rate, SpO2 and adverse events in HFNC group compared with standard oxygen therapy (SOT) and nasal continuous positive airway pressure (nCPAP) groups. A significant reduction of the incidence of treatment failure (risk ratio (RR) 0.50, 95% CI 0.40 to 0.62, p<0.01) was observed in HFNC group compared with SOT group, but there was a significant increase of the incidence of treatment failure (RR 1.61, 95% CI 1.06 to 2.42, p0.02) in HFNC group compared with nCPAP group. In subgroup analysis, LOS was significantly decreased in HFNC group compared with SOT group in low-income and middle-income countries.ConclusionThe systematic review suggests HFNC is safe as an initial respiratory management, but the evidence is still lacking to show benefits for children with bronchiolitis compared with SOT or nCPAP.

For a random variable with cumulative distribution function (CDF) ( ), the th quantile is defined as ( ) = inf : ( ) ≥ , where 0 < < 1 and inf denotes the infimum of the set . Quantile regression models the conditional quantile function of given covariates x, ( | x). Unlike mean regression, quantile regression is inherently robust to heavy-tailed distributions, outliers, and departures from parametric assumptions, as it characterizes conditional distributional features beyond the mean. Moreover, quantile regression is particularly well suited for settings in which tail heterogeneity is present, allowing covariate effects to vary across different parts of the conditional distribution rather than being summarized by a single average effect. For example, when studying the relationship between years of education and income, conventional mean regression methods such as ordinary least squares may yield estimates similar to those from median regression. However, education may have little association with income among low-income individuals while exerting a much stronger effect in the upper tail of the income distribution, reflecting pronounced heterogeneity between lower and upper quantiles that cannot be captured by mean-based approaches.In biomedical studies, observational data frequently involve early dropout, leading to nonignorable missingness. In such settings, inference based on conditional mean regression is fundamentally limited, since the conditional mean is generally not identifiable without strong parametric assumptions on either the outcome distribution or the missingness mechanism. Beyond capturing tail heterogeneity, quantile regression provides a robust alternative for analyzing missing data, as conditional quantiles remain identifiable for a range of quantile levels under censoring and are therefore less sensitive to missing observations. For many biomedical applications, it is of interest to estimate bent-line regression models, in which the target functional is piecewise linear and continuous across regions defined by unknown change points. However, censoring can induce substantial bias in both slope and change-point estimation for existing mean-based approaches. Motivated by an experimental autoimmune myasthenia gravis (EAMG) dataset, in Chapter 1 we propose a censored bent-line quantile regression (CBQR) framework that formulates the problem directly in terms of identifiable quantile functionals and circumvents parametric assumptions on the missingness mechanism. The resulting estimator is consistent, asymptotically normal, and easy to implement via bent-line quantile regression on an informative subset, with simulation studies and real-data analysis demonstrating substantial bias reduction under nonignorable missingness.In addition to tail heterogeneity, spatial data often exhibit substantial spatial heterogeneity. Existing spatial methods frequently struggle to capture heterogeneous patterns over complex domains or ignore distributional heterogeneity in the tails of the response. In Chapter 2, we introduce a quantile spatial modeling (QSM) framework that accommodates both spatial nonstationarity and tail heterogeneity through constant and spatially varying coefficients. We propose a smoothed quantile bivariate triangulation (SQBiT) method based on penalized splines on triangulations combined with convolution smoothing of the quantile loss. The proposed method effectively captures spatial nonstationarity while preserving important data features such as smoothness and shape over complex and irregular domains. Under mild regularity conditions, the estimator achieves the optimal convergence rate under the 2-norm. We further establish a Bahadur representation, which enables asymptotic normality for the constant coefficient estimator and facilitates construction of asymptotic confidence intervals. To improve finite-sample performance, we also develop a wild bootstrap procedure for inference. Simulation studies demonstrate the numerical and computational advantages of SQBiT over existing methods, and application to U.S. mortality data reveals how socioeconomic factors influence mortality rates differently across spatial regions and distributional tails.Modern spatial datasets are often massive in both volume and resolution, frequently exceeding the memory capacity of a single machine and posing substantial challenges for scalable statistical modeling. While SQBiT performs well for spatial data of moderate size, it does not scale efficiently to large spatial datasets. In Chapter 3, we propose a distributed inference framework for QSM that accommodates both constant and spatially varying coefficients through bivariate triangulation smoothing. The proposed framework is built on a surrogate loss induced by smoothed and decorrelated scores and employs a communication-efficient multi-round aggregation strategy. It achieves the global convergence rate for constant coefficients without requiring large local sample sizes and remains robust even when spatially varying components are imperfectly estimated on local machines. We establish asymptotic normality for the constant coefficient estimator and develop corresponding inference procedures. Simulation studies highlight the numerical performance of the proposed method, and its practical utility is demonstrated through an application to largescale U.S. census-tract–level data on coronary heart disease prevalence.