Objective To explore the expression of peripheral blood Nod-like receptor protein 3(NLRP3)inflammasomes,serum caveolin-1(Cav-1),and sphingosine 1-phosphate receptor 1(S1P1)in children with Kawasaki disease(KD),and to elucidate their associations with coronary artery lesion(CAL).Methods A total of 223 children diagnosed with KD were recruited from our hospital between March 2023 and December 2024 and served as the KD study group.These children were classified into the CAL group(n=71)and the non-CAL group(n=152)based on their CAL status.Additionally,223 healthy children who underwent physical examinations at our hospital were selected as the healthy control group.Clinical data,levels of routine laboratory test indices,peripheral blood NLRP3 inflammasomes,serum Cav-1,and S1P1 were compared among the groups.Risk factors for CAL in children with KD were analyzed,and the diagnostic value of peripheral blood NLRP3 inflammasomes,serum Cav-1,and S1P1 levels for CAL in children with KD was evaluated.Results The levels of NLRP3,caspase-1,ASC in peripheral blood and messenger ribonucleic acid(mRNA)of serum Cav-1 were significantly higher in the KD study group than in the healthy control group(P<0.05).Conversely,the serum level of S1P1 was significantly lower in the KD study group compared to the healthy control group(P<0.05).In the CAL group,the levels of peripheral blood white blood cell count(WBC),NLRP3,caspase-1,ASC mRNA,serum C-reactive protein(CRP),and Cav-1 were all higher than those in the non-CAL group(P<0.05),while the serum level of S1P1 was lower than that in the non-CAL group(P<0.05).The levels of NLRP3,caspase-1,ASC mRNA in peripheral blood,along with serum Cav-1 and S1P1,were identified as independent risk factors for CAL in children with KD(P<0.05).The results of receiver operating characteristic(ROC)analysis indicated that the combined test of the levels of NLRP3,caspase-1,ASC mRNA in peripheral blood,serum Cav-1,and S1P1 for diagnosing CAL in children with KD had an area under the curve(AUC)value of 0.926.This value was significantly higher than that of each individual index(0.844,0.785,0.821,0.843,0.833,P<0.05).Conclusions The levels of NLRP3 inflamma-tory vesicles in peripheral blood and serum Cav-1 were highly expressed in children with KD,whereas the serum S1P1 was poorly expressed.These indices may be involved in the development process of CAL in children with KD.Moreover,the combination of these indices is more beneficial for the diagnosis of CAL in children with KD.

Objective To explore the expression of peripheral blood Nod-like receptor protein 3(NLRP3)inflammasomes,serum caveolin-1(Cav-1),and sphingosine 1-phosphate receptor 1(S1P1)in children with Kawasaki disease(KD),and to elucidate their associations with coronary artery lesion(CAL).Methods A total of 223 children diagnosed with KD were recruited from our hospital between March 2023 and December 2024 and served as the KD study group.These children were classified into the CAL group(n=71)and the non-CAL group(n=152)based on their CAL status.Additionally,223 healthy children who underwent physical examinations at our hospital were selected as the healthy control group.Clinical data,levels of routine laboratory test indices,peripheral blood NLRP3 inflammasomes,serum Cav-1,and S1P1 were compared among the groups.Risk factors for CAL in children with KD were analyzed,and the diagnostic value of peripheral blood NLRP3 inflammasomes,serum Cav-1,and S1P1 levels for CAL in children with KD was evaluated.Results The levels of NLRP3,caspase-1,ASC in peripheral blood and messenger ribonucleic acid(mRNA)of serum Cav-1 were significantly higher in the KD study group than in the healthy control group(P<0.05).Conversely,the serum level of S1P1 was significantly lower in the KD study group compared to the healthy control group(P<0.05).In the CAL group,the levels of peripheral blood white blood cell count(WBC),NLRP3,caspase-1,ASC mRNA,serum C-reactive protein(CRP),and Cav-1 were all higher than those in the non-CAL group(P<0.05),while the serum level of S1P1 was lower than that in the non-CAL group(P<0.05).The levels of NLRP3,caspase-1,ASC mRNA in peripheral blood,along with serum Cav-1 and S1P1,were identified as independent risk factors for CAL in children with KD(P<0.05).The results of receiver operating characteristic(ROC)analysis indicated that the combined test of the levels of NLRP3,caspase-1,ASC mRNA in peripheral blood,serum Cav-1,and S1P1 for diagnosing CAL in children with KD had an area under the curve(AUC)value of 0.926.This value was significantly higher than that of each individual index(0.844,0.785,0.821,0.843,0.833,P<0.05).Conclusions The levels of NLRP3 inflamma-tory vesicles in peripheral blood and serum Cav-1 were highly expressed in children with KD,whereas the serum S1P1 was poorly expressed.These indices may be involved in the development process of CAL in children with KD.Moreover,the combination of these indices is more beneficial for the diagnosis of CAL in children with KD.

Objective:To evaluate the initial clinical outcome of applying a comprehensive debulking procedure centered on the digital and plantar flaps with comparatively healthy proximal pedicle to reconstruct the hypertrophic toes and forefoots in one-stage surgery in multiple toes macrodactyly in children.Methods:The clinical data of children with macrodactyly deformity treated by the Department of Burn and Plastic Surgery in Children’s Hospital of Chongqing Medical University from January 2022 to October 2023 were retrospectively analyzed. Design toe and plantar arbitrary flaps with a few vascular perforating branches which pedicle at the comparatively healthy proximal side and resect all tissues beyond the normal length. In severe toe, a composite tissue nail-flap with the artery was dissected to reconstruct the toenail. Fat debulking on the surface of deep plantar fascia as well as within the osseofascial sheath, resecting partially of the fatty infiltrated nerve, transverse and longitudinal osteotomy to shorten and narrowed phalanxes without epiphyseal block, arthroplasty and flexor tendon tightening were performed. Finally, toes shaped by wrapping toe flaps, and pelmas restored by plantar flaps which both with comparatively healthy proximal pedicle. The operation time, healing time, and whether the toes and toenails are preserved were all recorded. The maximum circumference of both foot, the difference in shoe size, the presence of skin ulcers, wound scars, toe webbing morphology, the presence of basic sensation, and the satisfaction of parents were followed-up after surgery. The modified follow-up questionnaire was used to evaluate the surgical effect, the total score is 0-12 points, and the higher the score, the better the surgical outcome. Descriptive methods was used for statistical analysis, and the measurement data conforming to normal distribution were expressed as Mean±SD.Results:A total of 15 patients were enrolled, including 11 males and 4 females. The median age at the time of operation was 2.75 years (0.9-10.8 years). There were 11 cases with 2 toes and 4 cases with 3 toes, a total of 34 toes involved. The average surgical duration was 4.13 hours (3.25 hours for 2 toes and 5.00 hours for 3 toes). Only one severe case with 3 toes involved was amputated the biggest toe ray and totally 2 toe nail flaps were harvested unsuccessfully intraoperative. Except 3 toes had distal skin partially necrosis and 2 nail flaps were completely necrotic which healed after dressing changes, the rest of the toes were healing well after operation. The average follow-up time was 4.8 months (3-11 months), the difference of circumference was less than 1.5 cm, as well as in length was less than 0.5 cm between feet and all children were able to wear the appropriate shoes with same size. A total of 4 toes failed to retain toenails, and 1 had a very thin toenail. Except for one case with insufficient web depth, the other toe webs were close to normal. There was no skin ulcer occurred, the basic sensation of the feet was present, and wound scars were inconspicuous. The score of the modified questionnaire was 10.54±0.88, all parents were satisfied with the results.Conclusion:Comprehensive procedure centered on the digital and plantar flaps with comparatively healthy proximal pedicle for debulking multiple toes macrodactyly in children could completely excise distal hypertrophic tissues in a single operation, and the size of the affected feet and toes can be greatly reduced to wearing shoes of the same size, and have a high success rate in preserving the toes, as well as nails. The reconstructed feet, toes and toe webbing have near-normal morphology, hidden scar, no ulcers after walked and achieve a good initial effect.

Objective:To evaluate the initial clinical outcome of applying a comprehensive debulking procedure centered on the digital and plantar flaps with comparatively healthy proximal pedicle to reconstruct the hypertrophic toes and forefoots in one-stage surgery in multiple toes macrodactyly in children.Methods:The clinical data of children with macrodactyly deformity treated by the Department of Burn and Plastic Surgery in Children’s Hospital of Chongqing Medical University from January 2022 to October 2023 were retrospectively analyzed. Design toe and plantar arbitrary flaps with a few vascular perforating branches which pedicle at the comparatively healthy proximal side and resect all tissues beyond the normal length. In severe toe, a composite tissue nail-flap with the artery was dissected to reconstruct the toenail. Fat debulking on the surface of deep plantar fascia as well as within the osseofascial sheath, resecting partially of the fatty infiltrated nerve, transverse and longitudinal osteotomy to shorten and narrowed phalanxes without epiphyseal block, arthroplasty and flexor tendon tightening were performed. Finally, toes shaped by wrapping toe flaps, and pelmas restored by plantar flaps which both with comparatively healthy proximal pedicle. The operation time, healing time, and whether the toes and toenails are preserved were all recorded. The maximum circumference of both foot, the difference in shoe size, the presence of skin ulcers, wound scars, toe webbing morphology, the presence of basic sensation, and the satisfaction of parents were followed-up after surgery. The modified follow-up questionnaire was used to evaluate the surgical effect, the total score is 0-12 points, and the higher the score, the better the surgical outcome. Descriptive methods was used for statistical analysis, and the measurement data conforming to normal distribution were expressed as Mean±SD.Results:A total of 15 patients were enrolled, including 11 males and 4 females. The median age at the time of operation was 2.75 years (0.9-10.8 years). There were 11 cases with 2 toes and 4 cases with 3 toes, a total of 34 toes involved. The average surgical duration was 4.13 hours (3.25 hours for 2 toes and 5.00 hours for 3 toes). Only one severe case with 3 toes involved was amputated the biggest toe ray and totally 2 toe nail flaps were harvested unsuccessfully intraoperative. Except 3 toes had distal skin partially necrosis and 2 nail flaps were completely necrotic which healed after dressing changes, the rest of the toes were healing well after operation. The average follow-up time was 4.8 months (3-11 months), the difference of circumference was less than 1.5 cm, as well as in length was less than 0.5 cm between feet and all children were able to wear the appropriate shoes with same size. A total of 4 toes failed to retain toenails, and 1 had a very thin toenail. Except for one case with insufficient web depth, the other toe webs were close to normal. There was no skin ulcer occurred, the basic sensation of the feet was present, and wound scars were inconspicuous. The score of the modified questionnaire was 10.54±0.88, all parents were satisfied with the results.Conclusion:Comprehensive procedure centered on the digital and plantar flaps with comparatively healthy proximal pedicle for debulking multiple toes macrodactyly in children could completely excise distal hypertrophic tissues in a single operation, and the size of the affected feet and toes can be greatly reduced to wearing shoes of the same size, and have a high success rate in preserving the toes, as well as nails. The reconstructed feet, toes and toe webbing have near-normal morphology, hidden scar, no ulcers after walked and achieve a good initial effect.

Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

Purpose To explore the application value of 1 024×1 024 reconstruction matrix combined with iterative reconstruction algorithm(Karl)in computed tomography angiography(CTA)of gastric vessels and tumor-supplying arteries.Materials and Methods Thirty patients with gastric tumors who underwent clinical gastric CTA from March to June 2022 at the First Affiliated Hospital of Dalian Medical University were prospectively collected.The original data of CT scan images were grouped and reconstructed.Group A used the conventional 512×512 matrix combined with Karl-5 reconstruction;group B used 1 024×1 024 large reconstruction matrix combined with different levels of Karl algorithm reconstruction,obtaining three subgroups:B1(Karl 5),B2(Karl 7)and B3(Karl 9).The CT and SD values of abdominal aorta at the origin of the left gastric artery,celiac trunk,splenic artery,hepatic artery and the subcutaneous fat tissue of the abdominal wall were measured,and the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.The image quality of each group was assessed by two observers using a 5-point scale.Results The two observers had good consistency in the evaluation of image quality(Kappa=0.782-0.789,P<0.05).Subjective scores for groups B1 to B3 were all better than those for group A,with the highest score in group B2(two-dimensional scores:χ2=27.309,24.250;three-dimensional scores:χ2=21.964,21.294;all P<0.05).The gastric artery system was involved in tumor blood supply in 25 cases of 30 gastric tumors,with the clarity rate of each vessel in group B2 being superior to group A.There were no statistically significant differences in CT values of vessels between groups A,B1 and B2(t=-1.918-2.720,P>0.05),and apart from the SD of the abdominal aorta and CNR of the hepatic artery,differences in SD values,SNR,CNR,and background noise between group B2 and group A were not significant(t=-5.909-5.768,P>0.05);images from B1 to B3 showed a gradual decrease in SD values(F=2.881-27.109,P<0.05)and a gradual increase in SNR and CNR(F=3.612-12.149,P<0.05)as the level of Karl algorithm increased.Conclusion 1 024×1 024 reconstruction matrix combined with Karl-7 can improve the image quality and enhance the display effect of gastric microvessels and tumor-supplying artery branches,which have good clinical application value.

Objective:To investigate the value of quantitative parameters of amide proton transfer-weighted (APTw) imaging and dynamic contrast-enhanced (DCE)-MRI for preoperative assessment of human epidermal growth factor receptor 2 (Her-2) gene expression in endometrial cancer (EC).Methods:This research conducted a diagnostic pilot study involving 68 patients with pathologically confirmed EC at the First Hospital of Dalian Medical University from August 2019 to August 2023. Patients were categorized into Her-2-positive group (33 cases) and Her-2-negative group (35 cases) based on postoperative Her-2 gene expression results. Utilizing the APTw and DCE-MRI sequences, quantitative parameters including the asymmetric magnetization transfer ratio (MTR asym) for APTw and the volumetric transfer constant (K trans), plasma volume fraction (V p), extracellular mesenchymal space (V e), and rate constant (K ep) for DCE-MRI were acquired for the lesion site. Statistical differences in the values of each quantitative parameter between the two groups were evaluated using two independent sample t test or Mann-Whitney U test. The study incorporated quantitative parameters and clinicopathological data of patients to identify independent predictors of EC Her-2 gene expression through logistic regression analysis. A diagnostic model was developed using binary logistic regression analysis. The effectiveness of the parameters and diagnostic model was evaluated using receiver operating characteristic curves. DeLong test was used to compare the differences between the areas under the curves (AUC). Results:The study found statistically significant differences in MTR asym, K trans, and V e between the Her-2-positive group and the Her-2-negative group ( Z=2.55, P=0.011; t=-2.03, P=0.047; t=-2.13, P=0.037). However, the differences in V p and K ep were not statistically significant ( Z=0.58, P=0.560; Z=0.19, P=0.849). MTR asym emerged as a significant independent predictor of Her-2 gene expression in EC ( OR=1.016, 95% CI 1.003-1.030, P=0.014). Incorporating MTR asym, K trans, and V e, the diagnostic model yielded an AUC (95% CI) of 0.745 (0.625-0.864). The AUC (95% CI) for MTR asym, K trans, and V e alone were 0.680 (0.551-0.808), 0.623 (0.485-0.760), and 0.656 (0.523-0.789) respectively. The differences in AUC between the diagnostic model and individual predictors MTR asym, K trans, and V e were not found to be statistically significant ( Z=1.40, 1.92, 1.37, P=0.163, 0.055, 0.171). Conclusion:The quantitative parameters of APTw and DCE-MRI sequences can preoperatively assess EC Her-2 gene expression from a different perspective, with MTR asym potentially serving as a valuable independent predictor.

Objective:To explore the consistency of MRI fast field echo resembling a CT using restricted echo-spacing (FRACTURE) and CT in the evaluation of knee and ankle bone changes.Methods:From November 2020 to November 2021, seventeen patients who underwent CT and MRI FRACTURE examinations of knee joint or ankle joint in the First Affiliated Hospital of Dalian Medical University were retrospectively collected, including 14 patients with knee joint examinations and 3 patients with ankle joint examinations. According to the number of joint components, 80 components were included, including 14 for femur and patella, 17 for tibia and fibula, and 3 for talus, scaphoid, medial cuneiform, medial cuneiform, lateral cuneiform and calcaneus, respectively. The fracture, hyperosteogeny, and bone destruction of the joint bones were evaluated by two observers using CT and FRACTURE images, respectively. Kappa test was used to analyze the consistency of CT and FRACTURE images between observers in the evaluation of joint bone lesions.Results:The Kappa values (95%CI) of the consistency evaluation of fracture, hyperosteogeny, and bone destruction by CT and FRACTURE images were 0.925 (0.823-1.027), 0.905 (0.799-1.011) and 0.895(0.752-1.038) respectively for observer 1, and were 0.963 (0.892-1.034), 0.933 (0.843-1.023) and 0.886 (0.731-1.041) respectively for observer 2. The Kappa values (95%CI) of the consistency evaluation of fracture, hyperosteogeny, and bone destruction by observers 1 and 2 via CT images were 1.000 (1.000-1.000), 0.937(0.851-1.023) and 0.945 (0.839-1.051) respectively, and that by FRACTURE images were 0.962 (0.888-1.036), 0.966 (0.899-1.033) and 0.836 (0.656-1.016) respectively.Conclusion:For the evaluation of fracture, hyperosteogeny, and bone destruction of knee joint and ankle joint, MRI FRACTURE sequence is highly consistent with CT.

Objective:To investigate the relationship between urinary polycyclic aromatic hydrocarbons(PAHs) metabolites and pulmonary function in community population.Methods:A total of 4 812 participants were recruited from two communities in Wuhan city from April to May 2011 and two communities in Zhuhai city in May 2012. Information of demographic characteristics and life style was collected by semi-structural questionnaire. Physical examination was performed and pulmonary function was measured. Morning urine was also collected. The concentration of 12 urinary PAHs metabolites was tested and classified into four types by chemical structure, including hydroxynaphthalene, hydroxyfluorene, hydroxyphenanthrene and hydroxypyrene. The level of pulmonary function in different group of urinary PAHs metabolites was compared by using covariance analysis. The association of the urinary PAHs metabolites and pulmonary function was analyzed by using generalized linear model, and the interaction of different population characteristics and life style on the association was analyzed.Results:The age of participants was(51.99±13.64) years old, and 67.66% ( n=2 565) of the population were women. The M ( P25, P75) of concentration of total urinary PAHs metabolites was 5.72 (3.91,8.72) μg/mmol Cr. After controlling for variables including age, gender, city, Waist-to-Hip Ratio, smoking status, drinking situation, physical activity, cooking meals at home or not, kitchen ventilation and exposure to dust as confounding factors, generalized linear model showed that each 1-unit increase in log-transformed levels of hydroxynaphthalene, hydroxyfluorene, hydroxyphenanthrene, hydroxypyrene and total PAHs was associated with 26.83 (95% CI: -48.18, -5.48) , 21.86 (95% CI: -40.49, -3.23), 26.18(95% CI: -48.27, -4.09), 34.95 (95% CI: -55.95, -13.94), and 35.23 (95% CI: -58.93, -11.54) ml reduction of FVC and 29.36 (95% CI: -47.23, -11.48), 20.79 (95% CI: -36.39, -5.19), 22.65 (95% CI: -41.15, -4.15), 31.44(95% CI: -49.03, -13.85), and 33.20 (95% CI: -53.04, -13.36) ml reduction of FEV 1 respectively (all P values<0.05). Compared to non-alcohol users and participants with home cooking, the association was more evident in alcohol users and participants without home cooking( P for interaction<0.05). Conclusion:The exposure to PAHs was associated with decreased pulmonary function, and the association was more evident in alcohol users and participants without home cooking.

Objective:To investigate the relationship between urinary polycyclic aromatic hydrocarbons(PAHs) metabolites and pulmonary function in community population.Methods:A total of 4 812 participants were recruited from two communities in Wuhan city from April to May 2011 and two communities in Zhuhai city in May 2012. Information of demographic characteristics and life style was collected by semi-structural questionnaire. Physical examination was performed and pulmonary function was measured. Morning urine was also collected. The concentration of 12 urinary PAHs metabolites was tested and classified into four types by chemical structure, including hydroxynaphthalene, hydroxyfluorene, hydroxyphenanthrene and hydroxypyrene. The level of pulmonary function in different group of urinary PAHs metabolites was compared by using covariance analysis. The association of the urinary PAHs metabolites and pulmonary function was analyzed by using generalized linear model, and the interaction of different population characteristics and life style on the association was analyzed.Results:The age of participants was(51.99±13.64) years old, and 67.66% ( n=2 565) of the population were women. The M ( P25, P75) of concentration of total urinary PAHs metabolites was 5.72 (3.91,8.72) μg/mmol Cr. After controlling for variables including age, gender, city, Waist-to-Hip Ratio, smoking status, drinking situation, physical activity, cooking meals at home or not, kitchen ventilation and exposure to dust as confounding factors, generalized linear model showed that each 1-unit increase in log-transformed levels of hydroxynaphthalene, hydroxyfluorene, hydroxyphenanthrene, hydroxypyrene and total PAHs was associated with 26.83 (95% CI: -48.18, -5.48) , 21.86 (95% CI: -40.49, -3.23), 26.18(95% CI: -48.27, -4.09), 34.95 (95% CI: -55.95, -13.94), and 35.23 (95% CI: -58.93, -11.54) ml reduction of FVC and 29.36 (95% CI: -47.23, -11.48), 20.79 (95% CI: -36.39, -5.19), 22.65 (95% CI: -41.15, -4.15), 31.44(95% CI: -49.03, -13.85), and 33.20 (95% CI: -53.04, -13.36) ml reduction of FEV 1 respectively (all P values<0.05). Compared to non-alcohol users and participants with home cooking, the association was more evident in alcohol users and participants without home cooking( P for interaction<0.05). Conclusion:The exposure to PAHs was associated with decreased pulmonary function, and the association was more evident in alcohol users and participants without home cooking.