Objective:To analyze the risk factors for children with severe community-acquired pneumonia (CAP) being admitted to the pediatric intensive care unit (PICU),and establish a clinical prediction model,then evaluate the clinical application value of this model.Methods:A retrospective analysis was performed on children diagnosed with severe CAP at the Children's Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University from January to June 2023.The children were divided into the PICU group and the non-PICU group based on whether they were admitted to PICU at admission.The differences in pediatric early warning score（PEWS），clinical characteristics，and laboratory test results between the two groups at their last visit before admission were compared. The independent risk factors for children with severe CAP admitted to PICU were analyzed,and a clinical prediction model was established,which was validated through the receiver operating characteristic (ROC) curve.Results:A total of 274 children were included,including 141 males and 133 females,with a median age of 50 (24,81) months. There were 43 cases in PICU group and 231 cases in non-PICU group.There were no statistically significant differences in gender and age between the two groups of children ( P>0.05). The PEWS score,white blood cell count,neutrophil count,neutrophil/lymphocyte ratio,procalcitonin (PCT),and lactate levels of children in the PICU group were significantly higher than those of children in the non-PICU group.While the duration of fever,peak temperature,and percutaneous arterial oxygen saturation (SpO 2) were significantly lower in the PICU group than those in the non-PICU group. All these differences were statistically significant ( P<0.05).Binary Logistic regression analysis showed that PEWS>4 points（ OR=6.583，95% CI 1.763 - 24.588， P<0.05），PCT>0.42 μg/L（ OR=19.046，95% CI 4.362-83.159， P<0.05），and SpO 2<93%（ OR=21.670，95% CI 3.843-122.184， P<0.05）were independent risk factors for children with severe CAP to be admitted to PICU.A clinical prediction model was constructed based on the above three independent risk factors.The area under ROC curve of the clinical prediction model was 0.941（95% CI 0.913-0.968， P<0.05），the sensitivity was 95.3%，the specificity was 80.5%，the positive predictive value was 83.0%，and the negative predictive value was 94.5%. Conclusion:For children with severe CAP，if they have PEWS > 4,an elevated PCT level，and a decreased SpO 2，it is recommended that they be admitted to PICU for further monitoring and treatment.The clinical prediction model for admission to the PICU for children with severe CAP，constructed by combining PEWS with commonly used clinical information in pediatric emergency，has a relatively high predictive efficacy and can provide a reference for the stratified diagnosis and treatment of children with severe CAP in the future.

Objective:To analyze the risk factors for children with severe community-acquired pneumonia (CAP) being admitted to the pediatric intensive care unit (PICU),and establish a clinical prediction model,then evaluate the clinical application value of this model.Methods:A retrospective analysis was performed on children diagnosed with severe CAP at the Children's Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University from January to June 2023.The children were divided into the PICU group and the non-PICU group based on whether they were admitted to PICU at admission.The differences in pediatric early warning score（PEWS），clinical characteristics，and laboratory test results between the two groups at their last visit before admission were compared. The independent risk factors for children with severe CAP admitted to PICU were analyzed,and a clinical prediction model was established,which was validated through the receiver operating characteristic (ROC) curve.Results:A total of 274 children were included,including 141 males and 133 females,with a median age of 50 (24,81) months. There were 43 cases in PICU group and 231 cases in non-PICU group.There were no statistically significant differences in gender and age between the two groups of children ( P>0.05). The PEWS score,white blood cell count,neutrophil count,neutrophil/lymphocyte ratio,procalcitonin (PCT),and lactate levels of children in the PICU group were significantly higher than those of children in the non-PICU group.While the duration of fever,peak temperature,and percutaneous arterial oxygen saturation (SpO 2) were significantly lower in the PICU group than those in the non-PICU group. All these differences were statistically significant ( P<0.05).Binary Logistic regression analysis showed that PEWS>4 points（ OR=6.583，95% CI 1.763 - 24.588， P<0.05），PCT>0.42 μg/L（ OR=19.046，95% CI 4.362-83.159， P<0.05），and SpO 2<93%（ OR=21.670，95% CI 3.843-122.184， P<0.05）were independent risk factors for children with severe CAP to be admitted to PICU.A clinical prediction model was constructed based on the above three independent risk factors.The area under ROC curve of the clinical prediction model was 0.941（95% CI 0.913-0.968， P<0.05），the sensitivity was 95.3%，the specificity was 80.5%，the positive predictive value was 83.0%，and the negative predictive value was 94.5%. Conclusion:For children with severe CAP，if they have PEWS > 4,an elevated PCT level，and a decreased SpO 2，it is recommended that they be admitted to PICU for further monitoring and treatment.The clinical prediction model for admission to the PICU for children with severe CAP，constructed by combining PEWS with commonly used clinical information in pediatric emergency，has a relatively high predictive efficacy and can provide a reference for the stratified diagnosis and treatment of children with severe CAP in the future.

Objective To investigate the characteristics and clinical significance of serum immunoglob-ulins in patients with Cronkhite-Canada syndrome(CCS).Methods This retrospective study included CCS patients admitted to Peking Union Medical College Hospital from December 2009 to September 2024 who under-went serum immunoglobulin testing.Clinical manifestations and ancillary examination results were analyzed ret-rospectively.Results Fifty-two patients were included(male:36[69.2%],female:16[30.8%]),with median onset age of 60(54-64)years and median diagnostic delay of 5(3-12)months.Common manifesta-tions included diarrhea(86.5%),abdominal pain(40.4%),hematochezia(19.2%),weight loss(86.5%),nail malnutrition(100.0%),pigmentation(88.5%),hair loss(84.6%),and hypogeusia(69.2%).Serum IgG reduction occurred in 21 patients(50.0%),while total IgE elevation was observed in 20(71.4%).Elevated serum IgG4 levels were noted in 11 patients(23.4%),with no significant clinical differences between IgG4-elevated and normal groups.IgG4 levels showed no statistical difference between active(n=43)and remission(n=27)groups.The hair loss rate was significantly higher in the total IgE-ele-vated group than that in the normal total IgE group(P=0.0383).Conclusions CCS patients exhibit periph-eral blood immunoglobulin disorders,with elevated IgE levels correlating with hair loss.This suggests an im-mune-mediated mechanism may underlie hair loss in CCS.

Objective:This study aimed to analyze the infection status of viral viruria within one year after kidney transplantation, its impact on renal allograft function, and associated risk factors.Methods:A retrospective case-control study was conducted, involving 370 patients who underwent allogeneic kidney transplantation at Renji Hospital, Shanghai Jiao Tong University School of Medicine, from January 1, 2020 to December 31, 2021. Urinary viral loads of BK virus (BKV), JC virus (JCV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) were detected using PCR fluorescent probe assays. Patients were categorized into infection and non-infection groups. Glomerular filtration rate (GFR) and tacrolimus trough concentration was measured during infections, and clinical data were collected. Univariate analysis was performed to identify risk factors for viral viruria.Results:The 1-year patient survival rate and graft survival rate were both 98.6%. The incidence rates of viral viruria were as follows: JCV (42.7%), BKV (29.7%), CMV (11.6%), and EBV (2.9%), with statistically significant differences among viruses ( P<0.001). Single viral infection accounted for 48% of cases, while co-infections were predominantly BKV+JCV (9%). JCV infection rates remained consistently high throughout the year (22.4%-28.9%), whereas BKV infections peaked at 3 months postoperatively (20.5%). Co-infection with low-load JCV (>2 000 copies/ml) and CMV (>6 000 copies/ml) led to a significant decline in GFR at 6 months post-transplantation [median difference: 16.7 ml/(min×1.73 m2), P=0.019]. Univariate analysis revealed that elevated tacrolimus trough concentration was independent risk factor for BKV (4.90 vs. 4.30 ng/ml, Z=4.29, P<0.001) and JCV infections (5.30 vs. 4.80 ng/ml, Z=4.25, P<0.001). Conclusion:High incidences of JCV and BKV infections were observed post-kidney transplantation. Co-infection with low-load JCV and CMV accelerates renal function impairment, highlighting the critical role of tacrolimus concentration management in reducing viral infection risks.

Radiomics can provide a large number of features derived from medical images, which can be correlated with certain biological characteristics and clinical endpoints. Delta radiomics enables the analysis of feature changes across different acquisition time points, typically before and after treatment. Compared with traditional radiomics, delta radiomics allows the evaluation of changes in radiomic features at different time points to better guide clinical diagnosis and treatment, thereby facilitating the development of personalized treatment plans for patients. Delta radiomics offers certain advantages in the differential diagnosis, prognosis prediction, treatment response assessment, and side effect evaluation of oncological diseases. This article reviews the applications of delta radiomics in the diagnosis and treatment of head and neck tumors, lung cancer, gastrointestinal tumors, pancreatic cancer, prostate cancer, breast cancer, and soft tissue tumors.

Objective:To analyze the clinical characteristics and outcomes of Haemophilus influenzae (Hi) meningitis in children. Methods:This is a retrospective case series study. This study included 34 Hi meningitis patients who admitted to Beijing Children′s Hospital, Capital Medical University, from January 1, 2010, to December 31, 2023. Data on clinical presentations, laboratory tests, hearing assessment and outcomes at discharge were collected. Patients were divided into 2 groups according to the outcome at discharge: favorable outcome group and unfavorable outcome group. Mann-Whitney U test and Fisher exact test was used to estimate the risk factors for an unfavorable outcome at discharge. Results:Thirty-four patients were enrolled. There were 16 males and 18 females. The age at onset ranged from 3 months to 12 years. Fever (34 patients (100%)), convulsions (17 patients (50%)), and coma (21 patients (62%)) were the common clinical presentations. Twenty-four patients (71%) developed complications. There were 15 patients (44%) needed treatment in the intensive care unit, 5 patients (15%) received intubation, and 4 patients (12%) had developed shock. The favorable outcome group included 23 patients, and the unfavorable outcome group included 11 patients. Female, patients with limb movement disability, dystonia, ventriculomegaly or hydrocephalus, and a concentration of glucose in the initial cerebrospinal fluid lower than 1 mmol/L were risk factors of unfavorable outcome at discharge (all P<0.05). Among the 23 patients (68%) in favorable outcomes group, 13 patients (57%) had data available on their long-term follow-up results, including 12 patients with favorable long-term outcomes and 1 patient with unfavorable long-term outcome. Among the 11 patients (32%) in unfavorable outcomegroup, 1 patient died, the other 10 patients (91%) had data available on their long-term outcomes. Eight patients had unfavorable long-term outcomes and 2 patients with favorable long-term outcomes. Patients who had unfavorable outcomes at discharge were at a greater risk of experiencing unfavorable long-term outcomes ( P=0.001). Conclusions:It is common for patients with Hi meningitis to have intracranial complications or develop into critical conditions. Patients who have limb movement disability, dystonia, ventriculomegaly or hydrocephalus, and who exhibit a concentration of glucose in the initial cerebrospinal fluid lower than 1 mmol/L tend to have unfavorable outcomes; they need to be assessed for sequelae.

Objective:Using bacterial culture as the gold standard, to evaluate the agreement of rapid antigen detection test (RADT) and rapid nucleic acid test (RNAT) in diagnosing group A Streptococcus (GAS) pharyngitis in pediatric outpatients, and assess their potential clinical utility. Methods:This cross-sectional study prospectively collected throat swab specimens and clinical data of 338 children diagnosed with acute pharyngitis at the Department of Outpatient Beijing Children′s Hospital, Capital Medical University, between July 2023 and February 2024. The specimens were tested for GAS bacterial culture, RADT and RNAT. Using bacterial culture results as the reference standard, Kappa consistency analysis was performed to assess the diagnostic concordance between RADT and RNAT. Chi-square test was used to compare clinical characteristics between cases diagnosed by different methods.Results:In the 338 children diagnosed with pharyngitis, 195 were male and 143 were female, with an age at the visit of 7.4 (5.9, 7.4) years. The positivive rates for GAS detection were 25.7% (87/338) by bacterial culture, 20.7% (70/338) by RADT, and 41.7% (141/338) by RNAT. In terms of diagnostic performance, RADT exhibited a higher specificity (96.8% (243/251)) and better agreement with bacterial culture results ( κ=0.73), whereas RNAT showed greater sensitivity (95.4% (83/87)) but lower specificity (76.9% (193/251)) and moderate agreement ( κ=0.61). Among the 87 children with positive bacterial culture for GAS, 56 were male and 31 were female, with an age at visit of 7.3 (6.2, 8.8) years. Clinically, body temperature predominantly ranged from 38.1 to 39.0 ℃ in 48 cases (55.2%), and common accompanying symptoms included sore throat 62 cases (71.3%), cough 33 cases (37.9%), and cervical lymphadenopathy or tenderness 16 cases (18.4%). On physical examination, tonsillar enlargement was present in 73 cases (83.9%) and exudate in 37 cases (42.5%). The McIsaac score was most frequently 4 points, observed in 37 cases (42.5%). Laboratory tests showed a peripheral white blood cell (WBC) count of 14.5 (12.3, 18.7)×10?/L and C-reactive protein (CRP) concentration of 22.0 (10.1, 41.4) mg/L. There were no statistically significant differences in the proportion of fever, sore throat, cough, tender cervical lymphadenopathy, tonsillar exudates, or tonsillar enlargement, nor in WBC count or CRP, among children who tested positive by RADT, RNAT, or bacterial culture (all P>0.05). Conclusions:Compared with bacterial culture,the RADT demonstrates higher specificity, while the RNAT exhibits greater sensitivity. Both methods show good concordance with culture results and may serve as effective adjunctive tools for the early screening of GAS pharyngitis.

Organ transplantation has brought new hope for patients with end-stage organ failure. However, post-transplant infections, immune rejection, and medication-related complications remain key challenges. The high incidence of post-transplant infections significantly affects long-term patient survival. In recent years, laboratory testing for pathogens related to organ transplantation has made significant progress, providing important support for clinical practice. Future advancements in laboratory testing needs to optimize techniques, integrate multidimensional clinical indicators, and improve the accuracy and practicality of pre-, intra-, and post-transplant monitoring. With the combination of basic research and clinical practice, transplant medicine is expected to achieve greater breakthroughs in improving patient prognosis and survival rates.

The prefrontal cortex (PFC) plays a pivotal role in orchestrating higher-order emotional and cognitive processes, a function that depends on the precise modulation of synaptic activity. Although pharmacological studies have demonstrated that dopamine signaling through dopamine D1 receptor (DRD1) in the PFC is essential for these functions, the cell-type-specific and molecular mechanisms underlying the neuromodulatory effects remain elusive. Using cell-type-specific knockout mice and patch-clamp recordings, we investigated the regulatory role of DRD1 on neurons and astrocytes in synaptic transmission and plasticity. Furthermore, we explored the mechanisms by which DRD1 on astrocytes regulate synaptic transmission and plasticity at the cellular level, as well as emotional and cognitive functions at the behavioral level, through two-photon imaging, microdialysis, high-performance liquid chromatography, transcriptome sequencing, and behavioral testing. We found that conditional knockout of the Drd1 in astrocytes (CKO^AST) increased glutamatergic synaptic transmission and long-term potentiation (LTP) in the medial prefrontal cortex (mPFC), whereas Drd1 deletion in pyramidal neurons did not affect synaptic transmission. The elevated level of d-serine in the mPFC of CKO^AST mice increased glutamatergic transmission and LTP through NMDA receptors. In addition, CKO^AST mice exhibited abnormal emotional and cognitive function. Notably, these behavioral changes in CKO^AST mice could be reversed through the administration of d-serine degrease to the mPFC. These results highlight the critical role of the astrocytic DRD1 in modulating mPFC synaptic transmission and plasticity, as well as higher brain functions through d-serine, and may shed light on the treatment of mental disorders.

Objective To investigate the characteristics and clinical significance of serum immunoglob-ulins in patients with Cronkhite-Canada syndrome(CCS).Methods This retrospective study included CCS patients admitted to Peking Union Medical College Hospital from December 2009 to September 2024 who under-went serum immunoglobulin testing.Clinical manifestations and ancillary examination results were analyzed ret-rospectively.Results Fifty-two patients were included(male:36[69.2%],female:16[30.8%]),with median onset age of 60(54-64)years and median diagnostic delay of 5(3-12)months.Common manifesta-tions included diarrhea(86.5%),abdominal pain(40.4%),hematochezia(19.2%),weight loss(86.5%),nail malnutrition(100.0%),pigmentation(88.5%),hair loss(84.6%),and hypogeusia(69.2%).Serum IgG reduction occurred in 21 patients(50.0%),while total IgE elevation was observed in 20(71.4%).Elevated serum IgG4 levels were noted in 11 patients(23.4%),with no significant clinical differences between IgG4-elevated and normal groups.IgG4 levels showed no statistical difference between active(n=43)and remission(n=27)groups.The hair loss rate was significantly higher in the total IgE-ele-vated group than that in the normal total IgE group(P=0.0383).Conclusions CCS patients exhibit periph-eral blood immunoglobulin disorders,with elevated IgE levels correlating with hair loss.This suggests an im-mune-mediated mechanism may underlie hair loss in CCS.