Objective:To investigate the clinical characteristics and prognostic factors of extracranial malignant rhabdoid tumors (eMRTs) in children.Methods:In this retrospective case series study, a retrospective analysis was conducted on clinical data of 21 eMRT patients admitted to Children′s Hospital of Nanjing Medical University from April 2018 to January 2023 and followed up until October 30, 2023.Patients were grouped according to their gender, age, tumor origin site, clinical staging, initial lactate dehydrogenase (LDH) level, extent of tumor resection, chemotherapy regimen, and radiotherapy.The Kaplan-Meier method was used to calculate the 2-year progression-free survival rate (PFS) and overall survival rate (OS) of the patients, and the Cox regression model was used to analyze the prognostic factors.Results:Among the 21 patients with eMRTs, there were 7 males and 14 females, with the age of onset of 24 (3-138) months.Immunohistochemistry showed that all tumor tissues of the patients did not secrete integrase interactor 1 (INI-1).Among them, 13 cases originated from the kidney, and 8 cases originated from extrarenal non-central sites.At the time of diagnosis, there were 4 cases in clinical stages Ⅰ-Ⅱ, 17 cases in stage Ⅲ-Ⅳ.Thirteen patients underwent complete tumor resection surgery, 7 underwent partial resection, and 1 only underwent biopsy.Among the 13 cases of renal rhabdoid tumors, 8 cases were treated with the AVDC (Epirubicin, Vincristine, Actinomycin D, Cyclophosphamide)/ICE (Ifosfamide, Carboplatin, Etoposide) regimen, and 5 cases were treated with the protocol for nephroblastoma; among the 8 cases of extrarenal non-central rhabdoid tumors, 5 cases were treated with the AVDC/ICE regimen, and 3 cases were treated with the commonly used protocol for soft tissue sarcoma.Thirteen patients received radiotherapy.One patient received consolidation therapy with autologous stem cell transplantation following chemotherapy and radiotherapy.As of October 2023, there were 14 survivors and 7 deaths.The overall 2-year PFS and OS were 56%(95% CI: 35.7%-88.5%) and 62%(95% CI: 43.2%-89.4%), respectively.Among the patients who received the AVDC/ICE alternating chemotherapy regimen, the 2-year PFS and OS were 73%(95% CI: 47.0%-100.0%) and 79% (95% CI: 56.4%-100.0%), respectively.Univariate Cox regression analysis showed that complete tumor resection, the AVDC/ICE alternating chemotherapy, and radiotherapy were associated with a better prognosis in children (all P≤0.05).Multivariate Cox regression analysis showed that whether to receive radiotherapy was an independent risk factor affecting the overall survival in children. Conclusions:eMRTs are more common in infants and young children, with high malignancy and invasiveness.There is currently no standard treatment.Complete tumor resection combined with the AVDC/ICE alternating chemotherapy and radiotherapy may improve the prognosis of children with eMRTs.

Objective To explore the distribution characteristics and drug resistance of 267 strains of pathogenic bacteria in the intensive care unit.Methods 180 specimens sent for examination from 180 patients admitted to the intensive care unit of Yiwu Central Hospital who developed hospital-acquired infections from January 2021 to November 2023 were collected,and the sites of infection and the sources of specimens of patients with hospital-acquired infections were counted.The distribution characteristics of the patient's protozoa were analyzed,and the drug resistance of major Gram-positive bacteria(Staphylococcus aureus,Staphylococcus epidermidis)and Gram-negative bacteria(Escherichia coli,Pseudomonas aeruginosa,and Klebsiella pneumoniae)was analyzed in combination with drug sensitivity assessment results.Results Among the 180 patients with hospital-acquired infections,pulmonary and urinary tract infections accounted for a relatively high proportion,and sputum and urine specimens accounted for a relatively high proportion of the samples submitted for examination.180 specimens were cultured for pathogenic bacteria and 267 strains of pathogenic bacteria were detected,of which Gram-positive bacteria accounted for 29.59%,Gram-negative bacteria accounted for 67.04%,and fungi accounted for 3.37%.From 2021 to 2023,the detection rates of Gram-positive bacteria and fungi showed an increasing trend,and Gram-negative bacteria detection rates showed a decreasing trend.Staphylococcus aureus had high sensitivity to linezolid and Staphylococcus epidermidis had high sensitivity to moxifloxacin and linezolid.Escherichia coli and Pseudomonas aeruginosa had high sensitivity to piperacillin/tazobactam,and Klebsiella pneumoniae had high sensitivity to cotrimoxazole,imipenem,and piperacillin/tazobactam.Conclusion The distribution of pathogenic bacteria in patients with hospital-acquired infections admitted to the intensive care unit mainly consisted of Staphylococcus aureus,Staphylococcus epidermidis and Escherichia coli,Pseudomonas aeruginosa,and Klebsiella pneumoniae,and there were varying degrees of resistance to antimicrobial drugs.The subsequent selection of clinical drugs should be cautious,and antimicrobials with high sensitivity should be prioritized.