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Wolan-Nieroda A, Wojnarska A, Mańko G, Kiper A, Guzik A, Maciejczak A. Assessment of rehabilitation effects in children with mild intellectual disability. Sci Rep 2023; 13:15541. [PMID: 37730865 PMCID: PMC10511505 DOI: 10.1038/s41598-023-42280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
Research on effectiveness of rehabilitation programmes continues to investigate impact of therapeutic interventions on various motor parameters in children with intellectual disability (ID). This study compared the effectiveness of rehabilitation, reflected by physical fitness, static balance, and dynamic balance measurements, in children with mild ID. A total of 70 children with mild ID were enrolled for the study and were divided into two equal groups based on their body mass index (BMI) percentile, reflecting obesity or normal weight. Physical fitness was assessed using the Eurofit Special Test, whereas balance was evaluated with single-leg stance and timed up and go tests. The examinations were performed twice: At the beginning and at the end of a six-month therapy programme. Improvements were shown in the muscle strength of the upper limbs (p < 0.001) and lower limbs (p = 0.001), flexibility (p = 0.005), and static balance (p < 0.001) for the entire cohort. The effects of rehabilitation did not differ significantly between the children with obesity and those with a normal weight. These results may be important from the viewpoint of clinical practice and preventive measures, as they present evidence showing that rehabilitation is equally effective in both obese and normal weight children with mild ID. Therefore, these findings may be of assistance to those designing therapeutic programmes in special education centres.
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Affiliation(s)
- Andżelina Wolan-Nieroda
- Department of Physiotherapy, College of Medical Sciences, Institute of Health Sciences, University of Rzeszów, Rzeszów, Poland
| | - Anna Wojnarska
- Students Scientific Club for Physiotherapy in Adults' and Children's Neurology, Medical College of the University of Rzeszów, Rzeszów, Poland
| | - Grzegorz Mańko
- Department of Biomechanics and Kinesiology, Institute of Physiotherapy, Jagiellonian University Collegium Medicum, Krakow, Poland
- ORNR "Krzeszowice", Rehabilitation Center, Krzeszowice, Poland
| | | | - Agnieszka Guzik
- Department of Physiotherapy, College of Medical Sciences, Institute of Health Sciences, University of Rzeszów, Rzeszów, Poland.
| | - Andrzej Maciejczak
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
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Manojlovic M, Roklicer R, Trivic T, Milic R, Maksimović N, Tabakov R, Sekulic D, Bianco A, Drid P. Effects of school-based physical activity interventions on physical fitness and cardiometabolic health in children and adolescents with disabilities: a systematic review. Front Physiol 2023; 14:1180639. [PMID: 37362446 PMCID: PMC10289231 DOI: 10.3389/fphys.2023.1180639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Background: This study aimed to examine the influence of school-based physical exercise programs on physical fitness and cardiometabolic health in children and adolescents with disabilities. Methods: Web of Science, Scopus, and PubMed were thoroughly searched to identify relevant investigations. To be included in the systematic review, studies needed to fulfill the following inclusion criteria: 1) performed school-based physical exercise interventions; 2) parameters evaluated referred to health-related physical fitness (HRPF), skill-related physical fitness (SRPF), and cardiometabolic health; 3) a sample of participants consisted of children and adolescents with disabilities; 4) the mean age of respondents was less than 18 years; and 5) were written in the English language. Results: After searching the databases, a total of 474 studies have been identified, 18 of them met the eligibility criteria, and their outcomes were presented. Relating to the respondents' characteristics, the investigations involved 681 children and adolescents with disabilities, out of which 440 were male and 241 female. Regarding types of physical exercise interventions, the most commonly implemented were combined aerobic and resistance training, aerobic exercise, sports games, adapted high-intensity interval training, as well as sprint interval training. The obtained results unambiguously demonstrated that applied exercise interventions improved HRPF components such as cardiorespiratory fitness, muscular fitness, and flexibility. In terms of the SRPF, agility, balance, coordination, and power were considerably enhanced following the school-based exercise. On the other hand, the influence on indices of body composition and cardiometabolic health is quite controversial. The majority of the available studies did not find favorable effects. Additionally, no adverse events were reported in 7 of 8 research, and adherence to exercise was approximately 92%. Conclusion: School-based physical exercise programs were very efficient in improving HRPF and SRPF in children and adolescents with disabilities, while the evidence concerning the variables of body composition and cardiometabolic health is inconclusive and warrants further investigations.
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Affiliation(s)
- Marko Manojlovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Roberto Roklicer
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
- Faculty of Education, Free University of Bozen-Bolzano, Brixen-Bressanone, Italy
| | - Tatjana Trivic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Rade Milic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Nemanja Maksimović
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Roman Tabakov
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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Li X, Huang J, Kong Z, Sun F, Sit CHP, Li C. Effects of Virtual Reality-Based Exercise on Physical Fitness in People with Intellectual Disability: A Systematic Review of Randomized Controlled Trials. Games Health J 2023; 12:89-99. [PMID: 36716183 DOI: 10.1089/g4h.2022.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
It is unclear whether virtual reality (VR)-based exercise can improve physical fitness in people with intellectual disability (ID). This systematic review therefore aimed to synthesize existing evidence regarding the efficacy of VR-based exercise on physical fitness in people with ID. Eligible articles were searched through six major electronic databases from inception until August 15, 2022. Returned studies were screened through predefined inclusion and exclusion criteria. Data from the included studies were then extracted and synthesized. A total of 13 randomized controlled trials were included and 12 of them were found to have good research quality. Different physical fitness outcomes were evaluated: (1) muscular fitness (d = 0.05-2.12; proportion of effect = 5/6), (2) cardiorespiratory fitness (d = 0.12-0.67; proportion of effect = 5/5), (3) flexibility (d = 0.81; proportion of effect = 1/2), (4) body composition (d = 0.10; proportion of effect = 2/3), (5) balance (d = 0.23-1.65; proportion of effect = 6/7), (6) coordination (d = 0.19-0.48; proportion of effect = 2/3), (7) speed and agility (d = 0.13-0.46; proportion of effect = 4/4), and (8) overall motor proficiency (d = 0.02-1.08; proportion of effect = 1/3). While there was some preliminary evidence showing that VR-based exercise could improve muscular fitness, cardiorespiratory fitness, balance, and speed and agility in individuals with ID, other outcomes showed less conclusive or limited positive evidence. Overall, additional studies are needed to understand the benefits of VR-based exercise on physical fitness in people with ID.
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Affiliation(s)
- Xuecheng Li
- School of Physical Education & Sports Science, South China Normal University, Guangzhou, China.,Adapted Physical Activity + Laboratory, South China Normal University, Guangzhou, China
| | - Jiafu Huang
- School of Physical Education & Sports Science, South China Normal University, Guangzhou, China.,Adapted Physical Activity + Laboratory, South China Normal University, Guangzhou, China
| | - Zhaowei Kong
- Faculty of Education, University of Macau, Macau, China
| | - Fenghua Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chunxiao Li
- School of Physical Education & Sports Science, South China Normal University, Guangzhou, China.,Adapted Physical Activity + Laboratory, South China Normal University, Guangzhou, China
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4
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Sun Y, Yu S, Wang A, Chan HCK, Ou AX, Zhang D, Xie Y, Fong SSM, Gao Y. Effectiveness of an adapted physical activity intervention on health-related physical fitness in adolescents with intellectual disability: a randomized controlled trial. Sci Rep 2022; 12:22583. [PMID: 36585423 PMCID: PMC9803657 DOI: 10.1038/s41598-022-26024-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022] Open
Abstract
This study aimed to examine the effects of an adapted physical activity (APA) intervention on health-related physical fitness (HRPF) in adolescents with intellectual disability (ID). With a randomized controlled trial design, adolescents aged 12-18 years, with mild and moderate ID, and being overweight and obese were recruited and randomly assigned to either an intervention or a control group. The APA intervention consisted of overall moderate intensity aerobic and resistance exercise, with a duration of 45 min/session, a frequency of 2 sessions/week, and lasting for 9 months. A negative control was involved, in which participants received no treatment. Changes in four fitness tests, including the 9-min run/walk, handgrip strength, 30-s sit-ups, and sit-and-reach tests, were assessed between the groups using general linear models. A total of 57 participants (39 in the intervention group and 18 in the control group) completed the study. Significant mean differences in changes in the 9-min run/walk test (413.6 m [95% CI 146.72 m, 680.41 m], p = 0.003) and the right-side sit-and-reach test (2.2 cm [95% CI 0.37 cm, 4.09 cm], p = 0.020) respectively were observed in the intervention group, compared to the control group. No significant between-group improvement was observed for the handgrip strength and the 30-s sit-ups tests. The APA intervention induced beneficial effects on cardiorespiratory fitness and potential beneficial effects on flexibility for adolescents with ID. However, no significant effects of this intervention on muscular strength and endurance were observed in this study. Future studies should consider involving effective exercises in interventions to improve muscular strength and endurance.
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Affiliation(s)
- Yan Sun
- grid.221309.b0000 0004 1764 5980Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Siyue Yu
- grid.10784.3a0000 0004 1937 0482JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Aiwei Wang
- grid.221309.b0000 0004 1764 5980Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Hardaway Chun-Kwan Chan
- grid.221309.b0000 0004 1764 5980Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China ,Scientific Conditioning Centre, Hong Kong Sports Institute, Hong Kong, China
| | - Alison Xiaoting Ou
- grid.221309.b0000 0004 1764 5980Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Dexing Zhang
- grid.10784.3a0000 0004 1937 0482JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yaojie Xie
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Shirley S. M. Fong
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, China ,grid.419993.f0000 0004 1799 6254Department of Health and Physical Education, Education University of Hong Kong, Hong Kong, China
| | - Yang Gao
- grid.221309.b0000 0004 1764 5980Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China ,grid.221309.b0000 0004 1764 5980Centre for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong, China
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Pierantozzi E, Morales J, Fukuda DH, Garcia V, Gómez AM, Guerra-Balic M, Carballeira E. Effects of a Long-Term Adapted Judo Program on the Health-Related Physical Fitness of Children with ASD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16731. [PMID: 36554612 PMCID: PMC9779502 DOI: 10.3390/ijerph192416731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Physical fitness is one of the most important physical and mental health aspects for children with Autism Spectrum Disorder (ASD). This study aimed to test the effects of a long-term adapted judo program on the health-related physical fitness of children with ASD. The participants were recruited from various associations of families and schools for children with special needs. Twenty-one children were assigned to an experimental group and nineteen to a control group. The experimental group participated in a six-month adapted judo program consisting of 90 min of practice each week. Health-related physical fitness was measured using the indicators obtained from the ALPHA-fitness battery, the estimated VO2max and the waist/height ratio0.5. Changes within and between groups were analyzed using linear mixed models for repeated measures designs and test-retest reliability of tests requiring a maximum score using the Intraclass Correlation Coefficient (ICC). A judo program tailored for children with ASD can improve the cardio-metabolic health and cardiorespiratory fitness of its participants. The problems involved with administering physical aptitude tests that involve maximum effort or performance in children with ASD cast serious doubts on the reproducibility of their results.
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Affiliation(s)
- Emanuela Pierantozzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 1700 Genoa, Italy
| | - José Morales
- Faculty of Psychology, Education Sciences and Sport Blanquerna—Ramon Llull University, 08022 Barcelona, Spain
| | - David H. Fukuda
- School of Kinesiology & Physical Therapy, University of Central Florida, Orlando, FL 32816, USA
| | - Vanessa Garcia
- Faculty of Psychology, Education Sciences and Sport Blanquerna—Ramon Llull University, 08022 Barcelona, Spain
| | - Antonia M. Gómez
- Faculty of Psychology, Education Sciences and Sport Blanquerna—Ramon Llull University, 08022 Barcelona, Spain
| | - Myriam Guerra-Balic
- Faculty of Psychology, Education Sciences and Sport Blanquerna—Ramon Llull University, 08022 Barcelona, Spain
| | - Eduardo Carballeira
- Department of Physical Education and Sport, University of A Coruna, 15179 Oleiros, Spain
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Mirza M, Brown-Hollie JP, Suarez-Balcazar Y, Parra-Medina D, Camillone S, Zeng W, Garcia-Gomez E, Heydarian N, Magaña S. Interventions for Health Promotion and Obesity Prevention for Children and Adolescents with Developmental Disabilities: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022:1-24. [PMID: 36032995 PMCID: PMC9395920 DOI: 10.1007/s40489-022-00335-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
This systematic review evaluated interventions and relevant outcomes for health promotion and obesity prevention among children and adolescents with developmental disabilities (DD). Twenty-one studies including randomized control trials (n= 9) and quasi-experimental studies (n=12) published between 2010 and 2021 met inclusion criteria related to participant characteristics, intervention type, and child obesity-related outcomes. Five types of intervention programs were identified: aerobic and strength training, sport-based physical activity, aquatic exercise, active video gaming, and diet and lifestyle. Whereas analysis of intervention outcomes, efficacy, and study rigor showed mixed results and weak evidence of effective interventions, this review identified gaps in the literature, promising strategies for addressing obesity in children with DD, and implications for practice and future research. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00335-5.
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Affiliation(s)
- Mansha Mirza
- University of Illinois, 1919 W Taylor., IL 60612 Chicago, USA
| | | | | | - Deborah Parra-Medina
- Latino Research Institute, University of Texas at Austin, 210 W. 24th St., Austin, TX 78712 USA
| | - Sarah Camillone
- University of Illinois, 1919 W Taylor., IL 60612 Chicago, USA
| | - Weiwen Zeng
- University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | | | - Nazanin Heydarian
- University of Texas Rio Grande Valley, 1201 W University Dr, Edinburg, TX 78539 USA
| | - Sandy Magaña
- University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
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Effects of Rhythm Step Training on Physical and Cognitive Functions in Adolescents: A Prospective Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10040712. [PMID: 35455889 PMCID: PMC9029147 DOI: 10.3390/healthcare10040712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Rhythm step training (RST) for sensorimotor dual tasks is in the spotlight as it provides physical activity that is fun and allows participants to express various and creative movements, although it lacks a scientific evidence base. Therefore, this study was to investigate how RST affects the physical and cognitive functions of adolescents. Materials and Methods: A total of sixty-six female middle-schoolers were divided into non-exercise group (control group, CON, n = 22), step training group (STG, n = 22), and rhythm step training group (RSTG, n = 22). To verify the combined effects of music-based rhythm and exercise, the program was conducted for 45 min/session a day, three times a week for 12 weeks. Results: RST scores increased significantly in the STG and RSTG compared to the CON after 12 weeks. Specifically, the Δ% of RST scores in the RSTG (11.44%) was higher than those of STG (9.01%) and CON (3.91%). By the end of the experiment, the power (p < 0.001), agility (p < 0.001), muscle endurance (p < 0.001), dynamic or static balance (p < 0.001), and gait velocity (p < 0.001) of RSTG were significantly improved compared to the others. The Δ% of all variables in RSTG was higher than those of the CON or STG. In addition, the verbal memory (p < 0.001) and attention (p < 0.001) of cognitive function were significantly improved in RSTG. Specifically, there was more of an increase in Δ% of RSTG for verbal memory (7.52%) and attention (10.33%) than in the CON (verbal memory, 3.34%; attention, 5.83%) or STG (verbal memory, 5.85%; attention, 5.43%). Conclusions: This study confirms that RST had a positive effect on the physical and cognitive functions of female middle-schoolers. We propose that rhythmic exercise combined with music is beneficial for adolescents’ physical and cognitive health.
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Analysis of the Relationship between Obesity Factors and Health-Related Physical Fitness Factors among People with Intellectual Disabilities in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126533. [PMID: 34204409 PMCID: PMC8296327 DOI: 10.3390/ijerph18126533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023]
Abstract
Little is known about the relationship between health-related physical fitness factors and obesity-related factors in individuals with intellectual disabilities. We investigated the prevalence of obesity and the relationship between obesity-related factors and health-related physical fitness factors among people with intellectual disabilities in South Korea to identify the physical fitness factors that influence the degree of obesity. For obesity-related factors, we measured body composition (height, weight, body mass index—BMI, and body fat percentage) of 108 subjects with intellectual disabilities (mean ± standard deviation; age = 24.4 ± 8.45 years). For health-related physical fitness factors, we measured muscular strength, muscular endurance, and flexibility. There was a significant negative correlation between muscular endurance and obesity factors (BMI, r = −0.306, p < 0.01; body fat percentage, r = −0.402, p < 0.01). Further, the prevalence of obesity (34.3%) and being overweight (17.6%) among people with intellectual disabilities was high in South Korea. In addition, muscular endurance was found to have a significant effect on the obesity level (β = −0.239, p < 0.000). This suggests that a program that considers muscular endurance should be prioritized when implementing an exercise intervention strategy for the treatment of overweight and obesity among people with intellectual disabilities.
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Guo YX, Ma HX, Zhang YX, Chen ZH, Zhai QX. Whole-Exome Sequencing for Identifying Genetic Causes of Intellectual Developmental Disorders. Int J Gen Med 2021; 14:1275-1282. [PMID: 33880059 PMCID: PMC8053495 DOI: 10.2147/ijgm.s300775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/22/2021] [Indexed: 01/29/2023] Open
Abstract
Background Intellectual developmental disorders (IDD) generally refers to the persistent impairment of cognitive activities and mental retardation caused by physical damage to the brain or incomplete brain development. We aimed to explore its genetic causes. Methods In this study, 21 IDD patients were recruited. The Gesell developmental scales (GDS) and Wechsler intelligence scale for children (WISC) were used to assess the impaired level of intellectual development for all probands. A superconducting MRI scanner (Philips AcsNT 3.0 T Philips, Best, The Netherlands) was used to perform a plain MRI scan of the skull on the probands. The whole-exome sequencing was carried out using next-generation sequencing in all probands and their families. Results Eight had seizures and four had typical characteristics of autism. Pregnancy and delivery were uneventful except for three patients. Moderate IDD (52.4%) accounted for the majority. The abnormal MRI results included ventriculomegaly, pachygyria, broadening external cerebral space, abnormal signal change and agenesis of corpus callosum. Eleven variants were identified, including the variant in CREBBP, MECP2, HCFC1, ATRX, RAB39B, CLCN4, DYRK1A and CASKgenes. The function areas result of gene-positive group were compared to that of gene-negative group. Not significant (p>0.05) items were revealed after this analysis. Conclusion Eleven variants were identified, including the variant in CREBBP, MECP2, HCFC1, ATRX, RAB39B, CLCN4, DYRK1A and CASK genes. The function areas result of gene-positive group were not significantly different from the gene-negative group.
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Affiliation(s)
- Yu-Xiong Guo
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510280, People's Republic of China.,Department of Pediatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Hong-Xia Ma
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510280, People's Republic of China.,Department of Pediatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China.,Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524000, People's Republic of China
| | - Yu-Xin Zhang
- Department of Pediatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Zhi-Hong Chen
- Department of Pediatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Qiong-Xiang Zhai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510280, People's Republic of China.,Department of Pediatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
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