The aim of this study was to examine the effect of calcitonin gene-related peptide (CGRP) on primary alveolar epithelial type II (AECII) cells and expression of Sonic hedgehog (SHH) signaling pathway components following exposure to hyperoxia. The AECII cells were isolated and purified from premature rats and exposed to air (21% oxygen), air + CGRP, hyperoxia (95% oxygen) or hyperoxia + CGRP. The production of intracellular reactive oxygen species (ROS) was determined using the 2',7'-dichlorofluorescin diacetate molecular probe. The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in the culture supernatant were detected by spectrophotometry. The apoptosis of AECII cells was assayed by flow cytometry, and the mRNA and protein expression levels of Shh and Ptc1 in the AECII cells were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), western blot analysis and immunofluorescence, respectively. The cellular pathological changes partly improved and apoptosis was markedly decreased upon treatment with CGRP under hyperoxic conditions. The levels of ROS in the hyperoxia + CGRP group were significantly lower than thoe in the hyperoxia group. In addition, the hyperoxia-induced increase in MDA levels and the decrease in SOD activity in the culture supernatant of the AECII cells were attenuated by CGRP. Compared with the cells exposed to air, hyperoxia markedly inhibited the mRNA and protein expression levels of Shh and Ptc1 in the AECII cells; however, this inhibition was partly attenuated by treatment with CGRP. On the whole, our data suggest that CGRP can partly protect AECII cells from hyperoxia-induced injury, and the upregulation of CGRP may be a potential therapeutic approach with which to combat hyperoxia-induced lung injury, which may be associated with the activation of the SHH signaling pathway.

OBJECTIVES: Mortality from pneumonia is three times higher in Asia compared with industrialized countries. We aimed to determine the epidemiology, microbiology, and outcome of severe pneumonia in PICUs across the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN). DESIGN: Prospective multicenter observational study from June 2020 to September 2022. SETTING: Fifteen PICUs in PACCMAN. PATIENTS: All children younger than 18 years old diagnosed with pneumonia and admitted to the PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical, microbiologic, and outcome data were recorded. The primary outcome was PICU mortality. Univariate and multivariable logistic regression was performed to investigate associations between PICU mortality and explanatory risk factors on presentation to the PICU. Among patients screened, 846 of 11,778 PICU patients (7.2%) with a median age of 1.2 years (interquartile range, 0.4–3.7 yr) had pneumonia. Respiratory syncytial virus was detected in 111 of 846 cases (13.1%). The most common bacteria were Staphylococcus species (71/846 [8.4%]) followed by Pseudomonas species (60/846 [7.1%]). Second-generation cephalosporins (322/846 [38.1%]) were the most common broad-spectrum antibiotics prescribed, followed by carbapenems (174/846 [20.6%]). Invasive mechanical ventilation and noninvasive respiratory support was provided in 438 of 846 (51.8%) and 500 of 846 (59.1%) patients, respectively. PICU mortality was 65 of 846 (7.7%). In the multivariable logistic regression model, age (adjusted odds ratio [aOR], 1.08; 95% CI, 1.00–1.16), Pediatric Index of Mortality 3 score (aOR, 1.03; 95% CI, 1.02–1.05), and drowsiness (aOR, 2.73; 95% CI, 1.24–6.00) were associated with greater odds of mortality. CONCLUSIONS: In the PACCMAN contributing PICUs, pneumonia is a frequent cause for admission (7%) and is associated with a greater odds of mortality.

Objective: The second year of undergraduate medical education is a critical phase transitioning from basic medical knowledge to specialized learning, requiring strong critical thinking abilities. Pediatric diseases, with their unique characteristics, demand active critical thinking from pediatricians. This study aims to investigate and analyze the critical thinking dispositions of second-year pediatric medical students, identify influencing factors, and propose recommendations for improving teaching methods. Methods: This cross-sectional study employed the Chinese version of the California Critical Thinking Disposition Inventory (CTDI-CV) and conducted an online survey among 240 second-year pediatric medical students at Chongqing Medical University, Chongqing, China. The study described the overall CTDI-CV scores and sub-dimension scores (mean ± standard deviation) and analyzed the distribution of critical thinking dispositions using t-tests and trend analysis. Results: A total of 229 students (95.4%) completed the survey, with 58.95% being female. The overall mean critical thinking score was 287.96 ± 39.09, and 139 students (60.70%) exhibited positive or highly positive critical thinking dispositions. Rural students scored lower than non-rural students (t = − 2.773, P = 0.0069), while only children scored higher than non-only children (t = 2.659, P = 0.0086). Higher high school academic ranking was associated with higher scores (H = 23.85, P < 0.001). Students whose parents had a bachelor’s degree or higher scored significantly better (t = 2.373, P = 0.0188). Interest in pediatrics was linked to higher scores (H = 15.36, P = 0.0015). Positive correlations were found between analyticity, inquisitiveness, and self-confidence (r ≥ 0.75). Conclusion: Second-year pediatric medical students in China generally display strong critical thinking abilities. Factors such as family background, academic performance, parental education level, and interest in pediatrics significantly influence these abilities. Pediatric educators should account for these individual differences to better enhance critical thinking development in students and improve teaching strategies accordingly.

Pediatric diseases possess unique characteristics, requiring pediatricians to have strong critical thinking skills and sound ethical decision-making abilities. This study aims to investigate and analyze the critical thinking dispositions of pediatric medical students and their impact on ethical decision-making levels, and to propose suggestions for improving teaching methods. A cross-sectional study design was adopted, using the Chinese version of the California Critical Thinking Disposition Inventory (CCTDI-CV) and an ethical decision-making questionnaire. An online survey was conducted among 240 pediatric medical students at Chongqing Medical University, collecting participants’ basic demographic information. The study described the CCTDI-CV scores and ethical decision-making questionnaire scores (mean ± standard deviation), with distribution and trend analyses performed using t tests and H-tests. Pearson correlation analysis was used to examine the relationship between the 2, and regression analysis was conducted to explore factors influencing ethical decision-making abilities. A total of 229 students (95.4%) completed the survey. The overall average score of critical thinking disposition among pediatric medical students was 287.96 ± 39.09, with 139 students (60.70%) demonstrating positive or highly positive critical thinking dispositions. Ethical decision-making abilities were excellent in 85 students (37.12%). There was a significant positive correlation between critical thinking abilities and ethical decision-making abilities (R = 0.774, P < .001), particularly with analysis abilities, systematic abilities, and cognitive maturity showing higher correlations with total ethical decision-making scores. CCTDI-CV scores had a significant positive impact on ethical decision-making levels (P < .001), with factors such as family background and high school performance also significantly influencing ethical decision-making abilities (P < .001). Chinese pediatric medical students generally exhibit strong critical thinking and ethical decision-making abilities. Critical thinking plays a crucial role in medical ethical decision-making, with family background and high school performance being important influencing factors. Educators should focus more on developing multidimensional critical thinking skills to enhance students’ ethical decision-making abilities, thereby improving overall healthcare service quality. The study results also provide new perspectives for international pediatric medical educators.

Background/Objectives: Decompressive craniectomy (DC) is commonly applied to manage refractory intracranial hypertension in severe traumatic brain injury (TBI). However, its role and benefits in pediatric populations remain uncertain. Clarifying whether DC provides measurable clinical advantages in children with severe TBI may inform treatment strategies and family counseling. Methods: We conducted a retrospective, one-to-one matched cohort study at a tertiary pediatric center (2014–2023). Fifty-three children with severe TBI who underwent DC were matched with fifty-three non-DC patients based on age, Glasgow Coma Scale score, cranial CT findings, and pupillary response at admission to ensure comparable injury severity. Demographic data, clinical features, and outcomes were collected. Primary outcomes were in-hospital mortality and Pediatric Cerebral Performance Category (PCPC) scores at discharge and 3 months. Secondary outcomes included duration of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay. Results: Mortality did not differ significantly between DC and non-DC groups (17.0% vs. 26.4%, p = 0.239). DC patients had better PCPC scores at discharge (p = 0.029). At 3 months, the between-group difference was not statistically significant but showed a near-significant trend (p = 0.057). No significant differences were observed in duration of ventilation (p = 0.100), ICU stay (p = 0.348), or hospital stay (p = 0.678). Conclusions: DC may not reduce short-term mortality in pediatric severe TBI but appears to be associated with more favorable neurological outcomes at discharge. Larger, adequately powered studies with standardized monitoring and longer follow-up are needed to clarify the durability and scope of potential benefits in this population.