Objective To explore the clinical characteristics,pathogens,inflammatory biomarkers,therapeutic methods and prognosis of necrotizing pneumonia (NP) in children.Methods The clinical data of children with NP who were admitted to the Department of Pediatrics of Shengjing Hospital of China Medical University from October 2010 to October 2015 were collected.The data included demographic data,laboratory test results,intrapulmonary complications,therapeutic methods and so on were analyzed,retrospectively.Results Forty-nine pediatric patients with NP were enrolled,31 cases were boys,18 cases were girls;the average age of the patients were 2.5 years (4 months-13 years).The average febrile time were (15.08 ± 5.92) d,and the hospital stay was (21.19 ± 10.83) d,respectively.The median value of peripheral blood leukocyte count was 17.7 × 109/L,the average of neutrophils ratio was (67.62 ± 18.52)％,and the median value of C-reactive protein (CRP) and procalcitonin (PCT) was 97.9 mg/L and 0.54 μg/L,respectively.Nineteen cases had Mycoplasma pneumoniae (MP) infection,16 cases with pneumonia chlamydia infection,9 cases complicated with MP and chlamydia pneumoniae infection,and 8 cases with positive bacterial culture,and 10 cases suffered from the intrapulmonary complications.Forty-seven cases got better prognosis with the treatment of antibiotics,glucocorticoids,intravenous immunoglobulin and other comprehensive therapeutic methods such as bronchoalveolar lavage with fiber bronchoscope and closed thoracic drainage.Conclusions NP is a severe complication of community-acquired pneumonia in children,and the occurrence of NP should be alerted in the children who have persistent high fever,higher inflammatory index and pleural effusion,but the great majority of patients do recover fully after comprehensive treatment.

Objective To report a case of pulmonary alveolar microlithiasis ( PAM) in Peking Union Medical Col-lege Hospital and to summarize the clinical features and genetic characters .Methods The clinical features , ima-ging results , pathology findings and SLC34 A2 gene mutation was analyzed and reported .Results The patient was a 35 years old male, presenting with cough and sputum for 10 years and worsen with short of breath for 3 weeks. Computed tomography of lung and pathology findings support the diagnose of pulmonary alveolar microlithiasis .And a heterozygous mutation c .A910 T in exon 8 of SLE34 A2 gene was discovered through genetic testing .Conclusions Since to the treatment is non-specific in this rare disease , it's significantly important to recognize this disease through early non-specific clinical features but typical imaging findings .And the finding that c .A910 T is more common in Asia population may provide us a potential target for screening and possible genetic engineering therapy .

Objective To investigate the correlation between exhaled nitric oxide and lung function (FEV1)in asthmatic children.Methods Fifty three stable asthmatic children aged 5 to 14 years old were recruited from ShengJing Hospital of China Medical University.According to whether the patients were treated with inhaled corticosteroid(ICS)therapy regularly,they were divided into two groups:steroid group and non-steroid group,then fraction of exhaled nitric oxide(FeNO)and lung function were measured.Results In non-steroid group,the levels of FeNO(mean 40.450±25.428 part by billion)were significantly higher than those in the steroid group(mean 19.879±13.845 part by billion),and they were statistically significant.(P = 0.003).The mean FEVI in non-steroid group was(95.152±8.993)%,and the mean FEVI in non-steroid group was(91.350±11.690)%,and there were no significant differences between two groups (P =0.189).Significantly negative correlation was found between FeNO and FEV1 in steroid group(r =-0.465,P = 0.039),but there was no significant correlation between them in steroid group(r = 0.058,P =0.747).Conclusion The levels of FeNO were higher in non-steroid group than those of the steroid group in the stable asthmatic children.FeNO is a good biomarker to evaluate the airway inflammation of asthmatic children.

OBJECTIVETo study the expression of EpCAM and E-cadherin in papillary thyroid carcinoma and to analyze its correlation with various clinicopathologic parameters.

METHODSImmunohistochemical study for EpCAM and E-cadherin was carried out in 91 cases of papillary thyroid carcinoma. Twenty-four cases of papillary hyperplasia of thyroid were used as controls.

RESULTSIn all of the 24 cases of papillary hyperplasia, EpCAM was located on the cell membrane, while in the 91 cases of papillary thyroid carcinoma studied, EpCAM was located within the cytoplasm, with 36.3% (33/91) showing nuclear localization as well. In all the papillary hyperplasia cases studied, E-cadherin showed membranous expression. E-cadherin expression was reduced in 84.6% (77/91) of papillary thyroid carcinoma, as compared with the surrounding native thyroid parenchyma. Amongst the 33 cases of papillary thyroid carcinoma which showed nuclear localization of EpCAM, 30 cases also showed reduced E-cadherin expression. There was a positive correlation between nuclear expression of EpCAM and loss of E-cadherin expression (P = 0.000; Spearman correlation coefficient = 0.857). Nuclear expression of EpCAM correlated with follicular variant of papillary thyroid carcinoma and presence of extrathyroidal extension ( P = 0.037 and 0.033, respectively). Loss of E-cadherin expression correlated with age of patients and presence of lymph node metastasis (P = 0.018 and 0.010, respectively).

CONCLUSIONSE-cadherin expression is reduced in papillary thyroid carcinoma, as compared with native thyroid parenchyma and papillary hyperplasia. Papillary thyroid carcinoma shows loss of EpCAM membranous expression and increased cytoplasmic/nuclear accumulation. Detection of these two markers may provide a valuable reference in defining the biologic behaviors of papillary thyroid carcinoma, including extrathyroidal extension and lymph node metastasis.

Antigens, Neoplasm ; metabolism ; Cadherins ; metabolism ; Carcinoma, Papillary ; metabolism ; secondary ; Cell Adhesion Molecules ; metabolism ; Cell Membrane ; metabolism ; Cytoplasm ; metabolism ; Epithelial Cell Adhesion Molecule ; Humans ; Lymphatic Metastasis ; Neoplasm Proteins ; metabolism ; Thyroid Neoplasms ; metabolism ; pathology

Objective To investigate the clinical,laboratory and imaging characterstics of refractory Mycoplasma pneumoniae pneumonia(RMPP) with lobar pneumonia change and efficacy of the therapy with different doses of glucocorticoids in children.Methods The clinical data of 103 children with Mycoplasma pneumoniae pneumonia(MPP) between September 2015 and February 2016 were investigated.Among the 103 children,there were 52 cases of RMPP and 51 cases of non-refractory MPP.The clinical features,laboratory examination and imaging characteristics were compared between the two groups.For the children with RMPP,the change of clinical symptoms and imaging were observed after the treatment with routine dose and large dose of glucocorticoids.Then,for the children with poor imaging,fiber bronchoscope can be used,the differences of airway mucosa injury and immune cells in the bronchoavleolar lavage fluid were compared after the treatment with routine dose and large dose of glucocorticoids.Results The children in the RMPP group had longer febrile time and hospital stay and were more likely to suffer from extrapulmonary complications.Peripheral blood neutrophil count,CRP,PCT,LDH and D-dimers were higher than these in the MPP group.At the same time it was more common that two or more pulmonary lobes were involved synchronally or pleural effusion appeared,the differences were statistically significant(P ＜ 0.05);There were no statistical differences that the clinical symptoms,imaging change,airway mucosa injury and the proportion of immune cells in BALF between the children in the RMPP group after the treatment with routine dose and large dose of glucocorticoids (P ＞ 0.05).Conclusion It should be alert to the occurence of RMPP in children with MPP when there was a persistent fever,extrapulmonary complications,increased levels of inflammatory index significantly,pleural effusion or two or more pulmonary lobes involvement.Compared with the treatment with routine dose of glucocorticoids in children with RMPP,it does not show a clear advantage with large dose of glucocorticoids on the clinical symptoms and inhibition of airway mucosa injury.

Rhinovirus(RV)is the most common respiratory virus that can cause infectious diseases of the upper and lower respiratory tract, such as the common cold and bronchiolitis.Among them, bronchiolitis is the main cause of wheezing attacks in infants under 2 years old, and the prevalence is increasing year by year.Early research believed that the main etiology was respiratory syncytial virus(RSV), but in recent years, more and more bronchiolitis has been found that caused by rhinovirus infection.This article takes rhinovirus-infected bronchiolitis as the entry point, and reviews its epidemiological characteristics, pathogenesis, clinical manifestations, auxiliary examination, treatment and prevention.

Antibiotic-associated diarrhea(AAD) is a frequent adverse effect of antibiotic in children.AAD is associated with longer hospitalization, higher healthcare cost and even lead to death.Pediatricians usually do not pay enough attention to AAD.Domestic experts from pulmonary medicine, infection and gastroenterology are organized to develop the consensus, to improve the diagnosis, treatment and prevention of AAD, and contribute the children health in future.

Objective:To analyze the clinical features, inflammatory markers and imaging characteristics of necrotizing pneumonia(NP) caused by Streptococcus pneumoniae(SPNP) in children. Methods:The clinical manifestations, laboratory data, imaging performances of both SPNP patients and children with NP caused by Mycoplasma pneumoniae (MPNP) admitted at the Department of Pediatrics, Shengjing Hospital of China Medical University from October 2010 to September 2018 were retrospectively analyzed.Their data were compared, and the indicators showing significant differences between the two groups were plotted into ROC curves in order to identify the indicators of SPNP. Results:There were 20 cases in the SPNP group, 40 cases in the MPNP group.Compared with the MPNP group, the patients in the SPNP group were younger[2.69(1.30-7.00) years vs.5.00(1.00-11.00) years], more likely to develop hypoxemia[45.0%(9/20 cases) vs.2.5%(1/40 cases)], and easier to combine with the extra-pulmonary complications[60.0%(12/20 cases) vs.17.5%(7/40 cases)], and they had longer hospital stay [28.00(16.00-58.00) days vs.15.50 (7.00 -27.00) days], and the differences were statistically significant (all P<0.05). Besides the number of white blood cell(WBC) [34.40(22.48, 44.17)×10 9/L vs.14.26 (10.04, 19.48)×10 9/L], neutrophils [0.88(0.78, 0.91) vs.0.76(0.62, 0.81)], C-reactive protein(CRP)[195.5(166.50, 237.75) mg/L vs.77.9 (45.33, 123.50) mg/L], procalcitonin (PCT) [2.82(0.67, 5.61) μg/L vs.0.18 (0.12, 0.50) μg/L]in the SPNP group were significantly higher than those in the MPNP group, and the differences were statistically significant (all P<0.05); but levels of albumin [(27.93±2.53) g/L vs.(32.99±3.54) g/L] and pro-albumin [(0.09±0.05) g/L vs.(0.19±0.05) g/L] in the SPNP group were significantly lower than those in the MPNP group, and the differences were statistically significant (all P<0.05). The necrotic changes occurred earlier in the CT scan of the SPNP group than that in the MPNP group[(9.10±2.69) d vs.(20.12±4.35) d], and the difference was statistically significant ( P<0.05). In the SPNP group, 19 cases had pleural effusion, of which 14 cases(70%) performed closed thoracic drainage and 1 case(5%) underwent pleural puncture.In the MPNP group, there were 24 cases (57.5%) of patients with pleural effusion and 10 cases (25%)with pleural puncture.The values of WBC [41 319.0(13 974.25, 125 991.75)×10 6/L vs.867.5(779.75, 976.25)×10 6/L] and lactate dehydrogenase [19 332.50(15 454.25, 24 307.50)U/L vs.2 711.50(2 012.00, 2 968.25) U/L] in the pleural effusion in the SPNP group were significantly higher than those in the MPNP group, while the pH values (7.07± 0.11 vs. 7.43±0.56)and glucose [0.28(0.25, 0.36) mmol/L vs.6.90(6.48, 6.99) mmol/L] in the pleural effusion decreased significantly, and the differences were statistically significant (all P<0.05). The ROC curves analysis showed that the cut-off values of the 4 predictors including WBC, neutrophil ratio, CRP and PCT were 17.66×10 9/L, 0.847, 157.50 mg/L, and 1.54 μg/L, respectively. Conclusions:NP in children is severe, however after active anti-infection and symptomatic support treatment, most patients have a good progress.When WBC >17.66×10 9/L, neutrophils ratio>0.847, CRP>157.50 mg/L or PCT 1.54 μg/L, are highly possibly SPNP.

BACKGROUND:Patients with degenerative cervical spondylosis often suffer from changed varicosity of the cervical spine,unbalanced neck-shoulder muscular strength,and descending power. OBJECTIVE:To probe into the correlation between sagittal curvature parameters and pain threshold for neck-shoulder muscles in degenerative cervical spondylosis. METHODS:Totally 50 patients with degenerative cervical spondylosis received treatment at the 3D Printed Outpatient Center of Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from January 2022 to March 2023 were included in the study.After excluding the 10 patients of cervical lateral projection that failed to meet the measurement conditions,the cervical lateral projections were shot to measure the following iconography parameters:Borden value and C2-7 Cobb angle as well as pain thresholds on the midpoint of the superior trapezius muscle in bilateral bundles and at 1 cm beside the C5-6 interspike.The correlation between sagittal curvature parameters and pain threshold of neck-shoulder muscles in degenerative cervical spondylosis was analyzed. RESULTS AND CONCLUSION:(1)The Borden value of sagittal curvature showed a moderately positive correlation with the bundle pain threshold in the left upper trapezius muscle,the bundle pain threshold in the right upper trapezius muscle,and the pain threshold at the 1 cm of the left side beside the C5-6 interspike(r=0.498,P<0.01;r=0.448,P<0.05;r=0.405,P<0.05)and a weak positive correlation with the pain threshold at the 1 cm of the right side beside the C5-6 interspike(r=0.322,P<0.05).(2)The C2-7 Cobb angle showed a weak positive correlation with the left squared myalgia threshold(r=0.355,P<0.05),and there was no correlation with the pain threshold of the left trapezius muscle and the pain threshold at the 1 cm of both sides beside the C5-6 interspike.(3)There was a correlation between the pain threshold of the neck-shoulder muscles,and a high correlation between the pain threshold of the left and right muscles and the pain threshold within the left and right side muscles,indicating that the neck-shoulder muscles are consistent and may be related to the coordination of the neck-shoulder movements.

The prevalence rate of tic disorder in Chinese children and adolescents is relatively high, and tic disorder is often co-occurring with psychiatric disorders such as attention deficit and hyperactive disorder and obsessive compulsive disorder.The cognitive impairments of tic disorder patients with different clinical types, course of disease and comorbidities are different, but all affect the learning and life quality of patients.Exploration of the cognitive function characteristics of tic disorder patients is conducive to further understanding of the disease and its etiological mechanism, and has guiding significance for clinical recognition, diagnosis and treatment.