Children with autism spectrum disorder (ASD) frequently present with co-occurring conditions that can influence autism symptom severity and complicate clinical management. However, studies with clinician-confirmed diagnoses in non-Western populations remain limited. In this multicenter cross-sectional study, 1279 children aged 3-14 years with DSM-5-confirmed ASD were recruited from eight medical centers in China. Autism symptom severity was assessed using the Childhood Autism Rating Scale (CARS). Comorbidities were identified through clinical evaluation and specialized assessments, and developmental status was measured using the Gesell Developmental Schedule (GDS) and Wechsler Intelligence Scales. Associations with CARS scores were analyzed using generalized linear regression. Of participants, 96.6% had at least one comorbidity and 71.2% had multiple comorbidities. Common conditions were intellectual developmental disorders (IDD) (87.3%), food selectivity (45.3%), insomnia disorder (16.9%), developmental regression (15.6%), and behavioral problems (14.6%). Patterns differed by sex and age: gastrointestinal problem and sleep-related interventions were more common in girls, whereas food selectivity was more common in boys. Older children showed higher rates of tic disorders, asthma, epilepsy, and offensive language, although these findings should be interpreted cautiously because the subgroup aged ≥ 6 years was small. In adjusted analyses, IDD, food selectivity, pica, insomnia disorder, and developmental regression were associated with higher CARS scores, whereas higher GDS and Wechsler scores were associated with lower CARS scores. In this Chinese cohort, comorbidities were prevalent and showed distinct sex- and age-related patterns. Several comorbidities were associated with greater autism symptom severity, underscoring the importance of comprehensive developmental and medical assessment in ASD care.

Background: Autism spectrum disorder (ASD) includes a range of multifactorial neurodevelopmental disabilities characterized by a variable set of neuropsychiatric symptoms. Immunological abnormalities have been considered to play important roles in the pathogenesis of ASD, but it is still unknown which abnormalities are more prominent. Methods: A total of 105 children with ASD and 105 age and gender-matched typically developing (TD) children were recruited. An eating and mealtime behavior questionnaire, dietary habits, and the Bristol Stool Scale were investigated. The immune cell profiles in peripheral blood were analyzed by flow cytometry, and cytokines (IFN-gamma, IL-8, IL-10, IL-17A, and TNF-alpha) in plasma were examined by Luminex assay. The obtained results were further validated using an external validation cohort including 82 children with ASD and 51 TD children. Results: Compared to TD children, children with ASD had significant eating and mealtime behavioral changes and gastrointestinal symptoms characterized by increased food fussiness and emotional eating, decreased fruit and vegetable consumption, and increased stool astriction. The proportion of gamma delta T cells was significantly higher in children with ASD than TD children (beta: 0.156; 95% CI: 0.888 similar to 2.135, p < 0.001) even after adjusting for gender, eating and mealtime behaviors, and dietary habits. In addition, the increased gamma delta T cells were evident in all age groups (age < 48 months: beta: 0.288; 95% CI: 0.420 similar to 4.899, p = 0.020; age > 48 months: beta: 0.458; 95% CI: 0.694 similar to 9.352, p = 0.024), as well as in boys (beta: 0.174; 95% CI: 0.834 similar to 2.625, p < 0.001) but not in girls. These findings were also confirmed by an external validation cohort. Furthermore, IL-17, but not IFN-gamma, secretion by the circulating gamma delta T cells was increased in ASD children. Machine learning revealed that the area under the curve in nomogram plots for increased gamma delta T cells combined with eating behavior/dietary factors was 0.905, which held true in both boys and girls and in all the age groups of ASD children. The decision curves showed that children can receive significantly higher diagnostic benefit within the threshold probability range from 0 to 1.0 in the nomogram model. Conclusions: Children with ASD present with divergent eating and mealtime behaviors and dietary habits as well as gastrointestinal symptoms. In peripheral blood, gamma delta T cells but not alpha beta T cells are associated with ASD. The increased gamma delta T cells combined with eating and mealtime behavior/dietary factors have a high value for assisting in the diagnosis of ASD.

Objective:To explore the regulatory effect of miR-873-5p micro-RNA targeting voltage-dependent anion channel protein 1 (VDAC1) in neurons and its mechanism.Methods:Murine nerve cells were randomly divided in vitro into a control group, a model group, a mimetic negative carrier (miR-con) group and an miR-873-5p group. The epileptiform hippocampal nerve cell model was induced in all of the cells except those in the control group using magnesium-free medium. The control group was normally cultured, while the miR-con and miR-873-5p groups were transfected with miR control and miR-873-5p RNA respectively. Real-time fluorescent quantitative polymerase chain reactions were used to detect the expression of miR-873-5p and VDAC1 mRNA. Western blotting was employed to detect VDAC1, B-cell lymphoma/leukemia-2 protein (Bcl-2), Bcl-2 associated X protein (Bax) and cleared caspase-3 in the neurons. The levels of reactive oxygen species (ROS), malondialdehyde (MDA) and glutathione (GSH) were measured using the DCFH-DA fluorescent probe, the thiobarbituric acid method and enzyme-linked immunosorbent assay respectively. Any apoptosis was detected using flow cytometry, while the targeting of miR-873-5p on VDAC1 was verified using the double fluorescence zymase reporter gene method.Results:Compared with the control group, a significant decrease in the average expression of miR-873-5p, Bcl-2 and in GSH and MDA levels was observed in the model group, but there was a significant increase in the average level of VDAC1, Bax, cleaved caspase-3 and ROS and in the rate of apoptosis. Compared with the miR-con group, a significant decrease in the average expression of Bax, cleaved caspase-3, ROS and in the apoptosis rate was observed in the miR-873-5p group, but there was a significant increase in the average level of Bcl-2, GSH and MDA. Moreover, it was verified that miR-873-5p reduced the expression of VDAC1.Conclusion:miR-873-5p protects damaged neurons by inhibiting their apoptosis through negatively regulating the target gene VDAC1 and the oxidative stress response.

目的 探讨脑瘫患儿血清胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平的变化及其临床意义.方法 以入院确诊为脑瘫的95例患儿为脑瘫组(CP组),选择同期体检健康的30例儿童为对照组,于入院后抽取静脉血,用化学发光免疫法测定其血清中的IGF-1含量,分析其与脑瘫发病程度的关系.结果 ①脑瘫患儿血清中 IGF-1水平分别为(33.96±2.73)μg/L,对照组为(65.23±5.97)μg/L,两组间比较有显著性差异(P均＜0.05);②不同浓度IGF-1对应的患儿粗大运动、精细动作、语言能力、社交行为及GMFM间评分两两比较均有显著差异(P＜0.05),与社会适应能力两两比较无显著差异(P＞0.05).结论 脑瘫患儿血清中IGF-1含量明显下降,且血清IGF-1与患儿粗大运动、精细动作、语言能力、社交行为水平呈正相关,血清中IGF-1浓度水平可作为评价脑瘫患儿脑损伤程度指标.

Objective To investigate the clinical effect of kinesitherapy combined with rTMS and BOTOX-A in the treatment of cerebral palsy. Method 94 cases with cerebral palsy were randomly divided into two groups, 47 cases in each group. The two groups were all given kinesitherapy, the observation group was plus rTMS and BOTOX-A on this basis. The course of treatment was 3 months, and the patients were followed up for l year. The clinical effect, MAS scores and GMFM-88 scores of the two groups were compared. ADL scores of the two groups before treatment and after 1 year follow up were compared. Results Total effective rate of the observation group (89.4％) was higher than that of the control group (70.2％)(P＜0.05). MAS scores of the two groups after treatment were significantly lower than those before treatment (P ＜ 0.01),GMFM-88 scores were significantly higher than those before treatment (P ＜0.01),the observation group changed more significantly than the control group (P＜0.01). After 1 year follow up, the ADL scores of the two groups were all significantly increased (P＜0.01),the observation group improved more significantly than the control group (P＜0.01). Conclusion The application of kinesitherapy combined with rTMS and BOTOX-A in the treatment of cerebral palsy has significant curative effect, it can significantly alleviated the muscle spasm degree of both lower limbs, and improve the motor function and activity of daily living.

Objective To observe the body fluid and cellular immune function of children with cerebral palsy. Methods A total of 42 cases of children with cerebral palsy who received rehabilitation in our hospital from March 2017 to March 2018 and 50 normal children were selected as the subjects. T lymphocyte subsets levels and humoral immune indicators of the subjects were tested by flow cytometry and immunoturbidimetry. Immune indexes of body fluid and cell of different severity of children with cerebral palsy were compared by the gross motor function test scale-88 (GMFM-88) score. Result There was no significant difference in T lymphocyte subsets between normal children and children with cerebral palsy (P＞ 0. 05). Humoral immunity index of children with cerebral palsy was significantly lower than that of normal children (P＜ 0. 01). The difference in humoral immunity among children with different severity of cerebral palsy was statistically significant (P＜ 0. 05). The more serious the child's condition was, the more serious the humoral immune deficiency was. Conclusions Children with cerebral palsy have humoral immune deficiency. The more serious the child's condition was, the more serious the humoral immune deficiency was. There was no significant difference in cellular immunity between children with cerebral palsy and normal children.

OBJECTIVETo study the effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy.METHODSA total of 97 children with spastic cerebral palsy were randomly divided into an observation group with 49 children and a control group with 48 children. Both groups were given routine rehabilitation training, and the children in the observation group were given suspension exercise training in addition. The scores of the D and E domains of the 88-item version of the Gross Motor Function Measure (GMFM-88) and Berg Balance Scale (BBS) were recorded before treatment and at 1, 3, and 6 months after treatment. Surface electromyography was performed to observe the changes in the root mean square (RMS) of surface electromyogram signals of the adductor muscle and the gastrocnemius muscle.RESULTSOver the time of treatment, both groups had varying degrees of improvement in the scores of the D and E domains of GMFM-88 and BBS. Compared with the control group, the observation group had significantly greater improvements in D and E functional areas and balance function (P<0.05). Both groups had reductions in the RMS of the surface electromyogram signals of the adductor muscle and the gastrocnemius muscle over the time of treatment, and the observation group had significantly greater reductions than the control group (P<0.05).CONCLUSIONSSuspension exercise training can effectively improve the motor and balance functions of children with spastic cerebral palsy.

目的 了解脑瘫患儿营养状况,分析相关影响因素,并探讨营养状况与脑瘫患儿生活质量的关系.方法 采用横断面研究,利用自行设计的调查表对2016年4月-2017年4月在郑州大学第三附属医院康复治疗的2～5岁的脑瘫患儿进行调查,中文版PedsQLTM4.0普适性核心量表评估其生活质量,并进行体格测量评估营养状况.用Logistic回归分析方法对影响脑瘫患儿营养的相关因素进行分析,并比较不同营养状况脑瘫患儿生活质量的差异.结果 共完成219例有效调查问卷,脑瘫患儿中低体重、生长迟缓、消瘦及超重或肥胖率分别为31.5％、39.7％、21.9％、8％;多因素二元Logistic回归分析示:粗大运动分级(GMFCS)水平[OR =2.61,95％(1.324,3.209)]、吞咽障碍[OR =3.047,95％(1.408,6.593)]、辅食添加(6月至1岁)[OR=0.088,95％ (0.03,0.254)]、出生体重[OR =0.516,95％ (0.309,0.862)]是影响营养状况的主要因素,其差异具有统计学意义(P＜0.05);营养不良的脑瘫患儿整体生活质量、生理功能及社交功能两个维度得分低于营养正常的脑瘫患儿,差异具有统计学意义(P＜0.01).结论 营养不良在脑瘫患儿中发生率较高,吞咽障碍和GMFCS分级水平是营养不良的危险因素.脑瘫患儿的生活质量不容乐观,营养不良患儿生活质量低于营养良好者.临床工作中要重视脑瘫患儿的营养干预.