Objective To investigate the diagnosis and treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP).Methods The clinical manifestations,diagnosis and treatment of 30 children with RMPP from January 2009 to December 2013 were analyzed retrospectively.Results Thirty children were accompanied by fever and intractable cough,fever type of relapsing fever,18 cases of elevated C-reactive protein (22-100 mg/L),1 case had sputum culture of Klebsiella pneumoniae,8 cases showed lower lung wild large patchy shadows,3 cases of pleural effusion,2 cases of pulmonary atelectasis,1 case had a pericardial effusion.Three cases of electrocardiogram abnormalities,3 cases of elevated creatine kinase isoenzyme-MB,2 cases of abnormal liver function,1 case of elevated troponin.Thirty cases cured completely,the smallest course was 12 d,the longest course was 4 months.There was 1 case of bronchiolitis obliterans caused by poor results.Conclusion RMPP should be given early diagnosis and analysis of its causes,on the basis of erythromycin infusion therapy,glucocorticoid and human immunoglobulin treatment should be carried out in a timely manner.

Objective:To investigate the nutritional risk and the incidence of malnutrition in children with recurrent abdominal Henoch Schonlein purpura(HSP), and observe the changes in the incidence of malnutrition after nutritional intervention.Methods:We retrospectively analyzed 90 children diagnosed with recurrent HSP in our hospital from 2017 to 2019.The cases were divided into two groups according to whether nutritional intervention was performed.The cases from January 2017 to May 2018 were chosen as the control group( n=42), and the cases from June 2018 to December 2019 were chosen as the experimental group( n=48). Based on the treatment of the primary disease, the high nutritional risk cases in experimental group were treated with extensively hydrolysed infant formula for nutritional intervention.The children were evaluated for nutritional risk with the STRONGkids nutrition tool.According to the score results, they were divided into high nutritional risk group and medium nutritional risk group.The Z score was used to evaluate malnutrition, and the degree of malnutrition was compared at admission and discharge. Results:Eighty-one children (90.0%) with recurrent abdominal allergic purpura had a high nutritional risk, 9 cases (10.0%)had a medium nutritional risk.There was no significant difference in the incidence of moderate and severe malnutrition between experimental group and control group at admission[39.6% (19/48) vs.40.5% (17/42), P>0.05]. The incidence of moderate and severe malnutrition in control group was higher than that in experimental group at discharge[66.7% (28/42) vs.22.9% (11/48), P<0.05]. Conclusion:In children with recurrent abdominal HSP, due to severe gastrointestinal symptoms and a high incidence of high nutritional risk, nutritional intervention with extensively hydrolysed infant formula can avoid the occurrence or aggravation of iatrogenic malnutrition during hospitalization.

Objective:To explore the structural characteristics of intestinal microflora in children with non-alcoholic fatty liver disease（NAFLD）and the relationship between intestinal microflora and the occurrence as well as development of NAFLD in children.Methods:Fifteen children with NAFLD diagnosed at the First People's Hospital of Yunnan Province from January 2022 to December 2022 were selected as subjects，and 15 healthy children who received routine physical examinations at the outpatient clinic during the same period were randomly selected as healthy control group.The height，weight，waist circumference，blood pressure，blood biochemistry of all children were collected.At the same time，the fresh fecal samples of all children were collected，and the biological information of intestinal flora was analyzed by 16S rRNA sequencing.Results:In the NAFLD group，there were eight males and seven females，with an average age of（11.13±1.77）years.In healthy control group，there were seven males and eight females，with an average age of（9.73±2.25）years.There were no significant differences in sex，age，blood pressure between two groups.Compared with the healthy control group，the levels of body mass index，waist circumference，waist-to-height ratio，alanine aminotransferase，aspartate transaminase，gamma-glutamyl transpeptidase，total bilirubin，direct bilirubin，unconjugated bilirubin，low density lipoprotein cholesterol，uric acid and serum insulin significantly increased and high density lipoprotein cholesterol significantly decreased in NAFLD group（ P<0.05）.The results of species diversity analysis showed that chaol index and observed-species index in NAFLD group were significantly higher than those in healthy control group（ P<0.05）.Species diversity analysis showed that the species with increased abundance in NAFLD group included：Proteobacteria，Gammaproteobacteria，Enterobacteriaceae，Klebsiella，Escherichia-Shigella，Escherichia-Shigella-unclassified.Differential species with increased abundance in the healthy control group included：Bifidobacterium species，Bifidobacterium，Bifidobacteriaceae，Bifidobacteriales，Actinobacteria，Actinobacteriota，Bacteroidia，Bacteroidales，Streptococcus-thermophilus. Conclusion:There are metabolic abnormalities and obvious changes in the structure of intestinal flora in children with NAFLD.Exogenous supplementation of Bifidobacterium，Streptococcus thermophilus and Bacteroides may prevent the occurrence of NAFLD，delay the progression of disease and improve fat deposition in the liver.

Objective:To evaluate the mechanism of short-chain fatty acids (SCFAs) reducing cognitive dysfunction in septic mice through transcriptomic analysis.Methods:Sixty SPF healthy adult male C57BL/6 mice, aged 8-12 weeks, weighing 20-25 g, were divided into 3 groups ( n=20 each) using a random number table method: sham operation group (Sham group), sepsis group (SEP group), and SCFAs+ sepsis group (SCFAs+ SEP group). Cecal ligation and puncture (CLP)was used to simulate a sepsis model in anesthetized animals. In SCFAs+ SEP group, 67.5 mmol/L acetate, 40 mmol/L butyrate, and 25.9 mmol/L propionate were added to drinking water starting from 14 days before CLP until 14 days after CLP. Y maze tests were conducted on days 4, 7 and 14 after surgery, with the number of mice in the Y maze test being the number of surviving mice on that day. On day 14 after surgery, 4 mice were selected in SEP group and SCFAs+ SEP group and sacrificed after anesthesia, and brain tissues were obtained to perform transcriptome sequencing, and enrichment analysis was performed using GO database and KEGG database. Finally, 5 mice were randomly sacrificed in each group, and brain tissues were collected and Western blot analysis was performed to verify the sequencing results. Results:Compared with Sham group, the number of times they entered the novel arm on days 4, 7 and 14 after surgery were significantly reduced, and the time spent in the novel arm was shortened in SEP group ( P<0.05). Compared with SEP group, the number of times they entered the novel arm on days 4, 7 and 14 after surgery was significantly increased, and the time spent in the novel arm was prolonged in SCFAs+ SEP group ( P<0.05). The results of transcriptomic analysis showed that 438 significantly differentially expressed genes were identified in SCFAs+ SEP group, of which the expression of 175 genes was up-regulated and the expression of 263 genes was down-regulated compared with SEP group. The expression of gamma-aminobutyric acid receptor rho-2 (GABRR2) in the brain tissues was significantly up-regulated in SEP group as compared with Sham group ( P<0.05). Compared with SEP group, the expression of GABRR2 in the brain tissue was significantly down-regulated in SCFAs+ SEP group ( P<0.05). There was no significant difference in the expression of GABRR2 in brain tissues between Sham group and SCFAs+ SEP group ( P>0.05). Conclusions:SCFAs may reduce cognitive dysfunction by down-regulating the expression of GABRR2 in septic mice.

Objective:To investigate the clinical manifestations, diagnosis, and treatment methods of Lophomonas blattarum infection combined with paragonimiasis in children, and improve pediatricians' understanding of the disease. Methods:The clinical data of two children with Lophomonas blattarum infection combined with paragonimiasis who received treatment in the Department of Pediatrics of The First People's Hospital of Yunnan Province were retrospectively analyzed. Children's clinical manifestation and diagnosis and treatment were analyzed. Relative literature was reviewed. Results:Case 1 had the onset of gastrointestinal symptoms. Case 2 had the onset of headache and liver dysfunction. Routine blood tests showed elevated eosinophils two cases and sputum examination results revealed the presence of live eggs of Lophomonas blattarum and paragonimiasis in two cases. Fecal roundworm eggs were also detected in case 1. Follow-up results showed that both cases were cured after treatment with metronidazole injection and praziquantel tablets. Conclusion:Lophomonas blattarum infection is a relatively rare opportunistic infection. Paragonimiasis is a natural parasitic disease that affects both humans and animals. Mixed infection of the two pathogens is rare. We hope that the findings from this paper will broaden clinical physicians' thoughts and guide clinical practice.

Objective:To investigate the value of 18F-prostate specific membrane antigen (PSMA)-1007 PET/CT in the detection of prostate cancer recurrence at low serum prostate specific antigen (PSA) level. Methods:From July 2018 to June 2019, 45 patients (age: 59-74 years) with suspected biochemical recurrence of prostate cancer with low PSA level (<2.0 μg/L) who underwent 18F-PSMA-1007 PET/CT examinations in Shanxi Tumor Hospital were retrospectively analyzed. Four patients with PSA<0.2 μg/L were not included in the statistical analysis due to the small sample. Among the remaining 41 patients with 0.2 μg/L≤PSA<2.0 μg/L, 10 were with 0.2 μg/L≤PSA<0.5 μg/L, 14 were with 0.5 μg/L≤PSA<1.0 μg/L, 17 were with 1.0 μg/L≤PSA<2.0 μg/L. PET/CT imaging were performed within 2 weeks after the examination of serum PSA. All patients were divided into low-moderate-risk group ( n=12) and high-risk group ( n=29) according to the National Comprehensive Cancer Network (NCCN) guidelines. χ2 test, Fisher′s exact test and Spearman rank correlation were used to analyze the data. Results:Patients were followed up for 7 (4-15) months, and all 45 patients were confirmed by pathology or follow-up. There were 31 patients with recurrence and 14 patients without recurrence. The sensitivity, specificity and accuracy were 100%(31/31), 13/14, 97.78%(44/45)respectively. One patient with PSA<0.2 μg/L presented retroperitoneal lymph node metastasis. Among 41 patients with 0.2 μg/L≤PSA<2.0 μg/L, 31(75.61%) were with at least one recurrent lesion by 18F-PSMA-1007 PET/CT. There were 20 cases of local recurrence, 13 cases of lymph node metastasis, 14 cases of bone metastasis. The detection efficacies of 18F-PSMA-1007 PET/CT were 5/10 for patients with 0.2 μg/L≤PSA<0.5 μg/L, 11/14 for those with 0.5 μg/L≤PSA<1.0 μg/L, and 15/17 for those with 1.0 μg/L≤PSA<2.0 μg/L ( χ2=4.641, P>0.05). The positive results of 18F-PSMA-1007 PET/CT were positively correlated with serum PSA value and risk group ( r values: 0.394, 0.384, both P<0.05). Conclusion:18F-PSMA-1007 PET/CT is a valuable tool for detecting biochemical recurrence of prostate cancer with low PSA level.