Objective: To investigate follow-up participation situation, negative conversion, and tuberculosis incidence among boarding junior and senior high school freshmen with latent tuberculosis infection(LTBI) in Zhuhai, so as to provide a reference for better LTBI management in school settings. Methods: A prospective cohort study enrolled 413 LTBI and 27 184 non LTBI boarding junior and senior high school freshmen in Zhuhai from September to October 2023. The LTBI group underwent follow up retesting at >3-6, >6-12, >12-24, >24 months after screening. The followup content included mycobacterium tuberculosis infection testing,chest X ray examination,and questionaire survey(basic demographic information, lifestyle, history of close contact with tuberculosis, and suspected symptoms of pulmonary tuberculosis). Follow-up participation, negative conversion, and tuberculosis incidence were analyzed. Rate was compared by using the Chi-square test, and factors associated with negative conversion were assessed by multivariate Logistic regression analysis. Results: Follow-up participation rates increased initially and then declined, with rates of 25.67% within >3-6 months, 37.05% within >6-12 months, 82.02% within >12-24 months, and 52.21% after 24 months. The overall negative conversion rate was 61.03%. The differences in the conversion rate to negative of mycobacterium tuberculosis infection detection among junior and senior high school freshmen in the LTBI group by different testing methods, school types, smoking history, sleep status, and academic stress were all statistically significant( χ 2=124.96, 22.70, 4.71, 6.31, 6.08, all P <0.05). Multivariate Logistic regression analysis identified testing methods, smoking history, and sleep status as factors associated with negative conversion ( OR =1.90-21.67, all P <0.05). The cumulative incidence of tuberculosis was 726.39 per 100 000 in the LTBI group versus 14.71 per 100 000 in the non-LTBI group ( RR =49.37, 95% CI =11.08-219.87, P <0.01). Conclusions Boarding junior and senior high school freshmen with LTBI in Zhuhai have a higher risk of tuberculosis than concurrent non-LTBI students; they therefore represent a priority group for tuberculosis prevention and control. Centralized follow up is recommended to improve participation, and high specificity methods should be used in follow up retesting and maintain consistency across assessments.

Objective To meet the clinical need for dynamic monitoring on lactate metabolism in septic shock pa-tients,a time-series prediction model based on a long short-term memory(LSTM)network was developed to predict 24-hour lactate clearance rate at admission.Methods A multi-stage retrospective cohort design was adopted to en-roll septic shock patients admitted to the department of critical care medicine of a hospital from January 2018 to Sep-tember 2024.By conducting univariate analysis and LASSO combined feature screening,predictive factors were extracted from multidimensional clinical data.An end-to-end LSTM framework(two-layer 64/32 units,dropout rate=0.3)was constructed.A sliding window strategy(six-hour step size)was adopted for dynamic prediction and compared with traditional logistic model in terms of three dimensions:calibration(Brier score),discrimination(area under the curve[AUC]of time-dependent receiver operating characteristic[ROC]),and clinical practicality(deci-sion curve analysis).Consistency between model prediction result and actual lactate clearance rate was analyzed,and the accuracy of prediction was evaluated.Results A total of 112 septic shock patients were enrolled in the analysis,including 65 males and 47 females,with an average age of(67.35±7.28)years.65 patients were assigned in the lactate good clearance rate group(lactate good clearance rate≥10％)and 47 in the lactate poor clearance rate group(lactate good clearance rate＜10％);78 patients were in the training set and 34 in the validation set.Time-depen-dent AUC analysis revealed that the predictive performance of the LSTM model in the time windows of 6,12,and 24 hours were 0.89(0.85-0.93),0.91(0.88-0.95),and 0.92(0.89-0.96),respectively,superior to the logistic regression model(ΔAUC=0.085,P＜0.01).The core predictive factors included APACHE Ⅱ score(OR=1.38),lactate level at admission(OR=1.65),vasoactive drug dosage(OR=1.42),and 6-hour fluid resuscitation dosage(OR=1.35).The Pearson correlation coefficient between the predicted value of the model and the actual 24-hour lactate clearance rate was 0.83(P＜0.001),with an average absolute error of 8.2％.Decision curve analysis confirmed that when the threshold probability was 15％-60％,the LSTM model could increase clinical net benefits by 27.3％.The validation of each subgroup showed that the model maintained the optimal predictive performance(AUC=0.87)in the lung infection subgroup(n=16).Conclusion The LSTM-based dynamic prediction model for predicting 24-hour lactate clearance rate through integrating early admission indicators demonstrates excellent pre-dictive performance and clinical application value,which can provide important reference for individualized treatment decisions in septic shock patients.

Objective To study the influencing factors of intradialytic hypotension(IDH)in diabetic maintenance hemodialysis(MHD)patients,and to provide references for clinical prevention of IDH quality control.Methods A total of 200 diabetic patients from four hemodialysis centers in Beijing from March 2022 to September 2022 were collected as the research objects.According to the definition of IDH[systolic blood pressure during hemodialysis≤90 mmHg(1 mmHg=0.133 kPa)or systolic blood pressure reduction during dialysis≥30 mmHg],the patients were divided into IDH group(frequency of hypotension events during dialysis≥30%during 7 months of follow-up)and non-IDH group.Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of IDH.receive operating characteristic curve(ROC)curve analysis was used to evaluate the predictive value of each influencing factor for IDH.Results Univariate analysis showed that compared with non-IDH group,IDH group had higher systolic blood pressure,higher blood glucose and lower serum albumin before dialysis(P<0.05).There were more patients with orthostatic hypotension in the IDH group than in the non-IDH group(P<0.05).Multivariate Logistic regression analysis showed that pre-dialysis systolic blood pressure,orthostatic hypotension and serum albumin were the influencing factors of IDH(P<0.05).ROC curve was used to evaluate the diagnostic accuracy of pre-hemodialysis systolic blood pressure for IDH.The area under the ROC curve was 0.787(95%CI:0.720-0.854,P<0.001),the threshold of IDH predicted by the Jorden index was 153 mmHg,the sensitivity was 75.5%,and the specificity was 75.4%.Conclusion Pre-hemodialysis systolic blood pressure,blood albumin and postural hypotension are independent factors of IDH in diabetic patients.In order to predict the occurrence of IDH,the pre-hemodialysis systolic blood pressure threshold was 153 mmHg.

Objective To investigate the effect of forsythigenin on the malignant progression of lung cancer cells by regulating the cyclic adenosine monophosphate/exchange protein directly activated by cAMP1/Ras-associated protein 1(cAMP/EPAC1/RAP1)signaling pathway.Methods Lung cancer cell line A549 was cultured in vitro and grouped into the control group,the low dose forsythigenin group(25 mg/L),the medium dose forsythigenin group(50 mg/L),the high dose forsythigenin group(100 mg/L),the high dose forsythigenin+specific increase in intracellular cAMP content(pertussis toxin PTX)group(100 mg/L forsythigenin+5 μmol/L PTX)and high dose forsythigenin+EPAC1 antagonist(ESI-09)group(100 mg/L forsythigenin+1.5 μmol/L ESI-09).CCK-8 experiment was applied to detect cell proliferation.Scratch test was applied to detect cell migration.Flow cytometry was applied to detect cell apoptosis.Transwell was applied to detect cell invasion.ELISA method was applied to detect cAMP level in cell supernatant.Western blot assay was applied to detect expression levels of cAMP/EPAC1/RAP1 signaling pathway proteins and apoptotic proteins[B lymphoblastoma-2(Bcl-2)and Bcl-2 associated X protein(Bax)].Results Compared with the control group,the OD450 value of A549 cells,number of cell invasions,scratch healing rate,level of cAMP,expression levels of Bcl-2,EPAC1 and RAP1 proteins were significantly reduced in the low dose,medium dose and high dose forsythigenin groups,and the expression of Bax protein and the rate of cell apoptosis were significantly increased in a dose-dependent manner(P＜0.05).Compared with the high-dose forsythigenin group,the OD450 value of A549 cells,scratch healing rate,number of cell invasions,level of cAMP,expression levels of Bcl-2,EPAC1 and RAP1 proteins were obviously increased in the high-dose forsythigenin+PTX group,the expression of Bax protein and the apoptosis rate were obviously reduced(P＜0.05).Levels of all indexes in the high dose forsythigenin+ESI-09 group were opposite.Conclusion Forsythigenin inhibits proliferation,migration,and invasion of A549 cells and promotes apoptosis by down-regulating the cAMP/EPAC1/RAP1 signaling pathway.

Objective:To analyze the efficacy of laparoscopic partial splenectomy and devascularization (LPSPD), open partial splenectomy and devascularization (OPSPD), laparoscopic total splenectomy and devascularization (LTSPD), and open total splenectomy and devascularization (OTSPD) in the treatment of portal hypertension.Methods:Clinical data of 128 patients with portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the Affiliated Hospital of Qinghai University and the General Surgery Department of the Fifth Medical Center of the Chinese PLA General Hospital from May 2018 to May 2022 were retrospectively analyzed, including 69 males and 59 females, aged 51.0±10.9 years. According to different surgical methods, patients were divided into four groups, namely the LPSPD group ( n=30), the OPSPD group ( n=32), the LTSPD group ( n=31), and the OTSPD group ( n=35). Operation time, postoperative hospitalization time, postoperative complications such as newly occurred PVT, etc of the four groups of patients were compared. Results:The operation times of the LPSPD, OPSPD, LTSPD and OTSPD group were 240.0 (180.0, 399.0), 209.5 (169.0, 259.0), 207.0 (175.3, 297.5) and 200.0 (162.0, 264.0) minutes, respectively. The postoperative hospital stays were 8.0 (7.0, 12.0), 10.0 (8.3, 11.8), 11.0 (9.0, 13.0) and 13.0 (11.0, 15.0) days, respectively. The incidences of newly occurred PVT after surgery were 3.3% (1/30), 3.1% (1/32), 19.4% (6/31), and 20.0% (7/35), respectively. The above indicators were compared among the four groups respectively, and the differences were statistically significant (all P<0.05). The postoperative hospital stay of the LPSPD group was shorter than that of the LTSPD group [8.0 (7.0, 12.0) vs 11.0 (9.0, 13.0), d, Z=-3.93], and the postoperative hospital stay of the OPSPD group was also shorter than that of the OTSPD group [10.0 (8.3, 11.8) vs 13.0 (11.0, 15.0), d, Z=-3.56; all P<0.001]. The incidence of newly occurred PVT after surgery in the partial splenectomy group (LPSPD and OPSPD) was 3.2% (2/62), which was lower than that in the total splenectomy group [LTSPD and OTSPD, 19.7% (13/66), χ2=8.38, P=0.004]. Conclusion:Compared to total splenectomy, partial splenectomy might be favorable for the shortened postoperative hospital stay and lower incidence of newly occurred portal vein thrombosis.

Objective:To identify the risk factors for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (HID-HSCT) .Methods:A total of 141 AML patients who underwent HID-HSCT at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from January 2020 to July 2021 were included. The cumulative incidence of aGVHD was analyzed using the Fine-Gray competing risk model, with relapse and death as competing events, to compare differences between groups. Potential risk factors were evaluated by univariable and multivariable Cox proportional hazards regression analyses to determine their independent effects on aGVHD.Results:Among the 141 patients, 86 (61.0%) were male and 55 (39.0%) were female, with a median age at transplantation of 34 years. Within 100 days post-transplant, 59 patients developed grade Ⅱ-Ⅳ aGVHD, whereas 86 patients experienced no or grade Ⅰ aGVHD (the grade 0-Ⅰ aGVHD group) . Survival analysis showed that the 3-year overall survival was 68.7% (95% CI: 57.7%-81.9%) in the grade Ⅱ-Ⅳ aGVHD group, compared with 78.8% (95% CI: 70.4%-88.3%) in the grade 0 - Ⅰ aGVHD group, with the difference not being statistically significant ( P=0.190) . Univariable analysis identified donor age ( P=0.020, HR=1.020, 95% CI: 1.000-1.040) and the female donor-male recipient sex combination ( P=0.033, HR=1.980, 95% CI: 1.160-3.380) as risk factors for grade Ⅱ-Ⅳ aGVHD. Multivariable analysis confirmed that donor age ( P=0.005, HR=1.026, 95% CI: 1.008-1.047) and the female donor-male recipient sex combination ( P=0.002, HR=2.339, 95% CI: 1.354-4.037) were independent risk factors for aGVHD. Patients receiving grafts from donors aged >45 years had a significantly higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD compared with those receiving grafts from donors ≤45 years [54.7% (95% CI: 42.3%-67.0%) vs 31.6% (95% CI: 21.0%-42.1%) , P=0.006]. Similarly, patients with the female donor-male recipient sex combination had a higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with other sex combinations [56.8% (95% CI: 40.4%-73.1%) vs 36.9% (95% CI: 27.5%-46.3%) , P=0.015]. Conclusion:Older donor age and the female donor-male recipient sex combination remain independent risk factors for aGVHD in patients with AML undergoing HID-HSCT.

Objective:To summarize the clinical characteristics of focal cerebral arteriopathy (FCA) in children, and to analyze its influencing factor of prognosis.Methods:A retrospective cohort study was conducted. Clinical data from 40 children with FCA who were hospitalized at the Department of Neurology, Beijing Children′s Hospital, Capital Medical University, from September 2015 to August 2024 were collected. A centralized follow-up was conducted in October 2024 via outpatient clinics or the internet. The pediatric stroke outcome measure (PSOM) was used to evaluate their outcomes. Based on the PSOM, the children were further divided into a group with normal neurological function and another group with abnormal neurological function. Differences between groups were analyzed using the Mann-Whitney U test and Fisher exact test. Univariate Logistic regression analysis was performed to identify the influencing factors for neurological outcomes in children with FCA. Results:A total of 40 children were included, with 20 males and 20 females, and the onset age of 9.2 (6.8, 12.5) years. Among them, 12 cases (30%) had a history of varicella within 1 year before onset. There were 23 cases (58%) presenting with transient ischemic attack (TIA) or recurrent fluctuating symptoms of onset, while 3 cases (8%) developed progressive stroke within the first month of onset. The M1 segment of the middle cerebral artery was the most commonly affected vascular site, with a total of 16 cases (40%). Arterial occlusion occurred in 8 cases (20%). Lumbar puncture was completed in 36 children, and white blood cell counts in cerebrospinal fluid was increased in 6 cases. All 23 patients who completed magnetic resonance vessel wall imaging (VWI) showed circular enhancement of the arterial wall. A total of 28 patients (70%) received antiplatelet or anticoagulation therapy, and 16 patients (40%) received hormone therapy. At admission, the pediatric National Institute of Health Stroke Scale (PedNIHSS) score was 6.0 (2.0, 8.8) points, which decreased to 0.5 (0, 3.0) points at discharge. The follow-up duration was 1.6 (0.8, 4.9) years, with 1 case lost to follow-up. There was 1 case presenting with recurrence course manifesting as TIA. Among the 39 cases who completed the follow-up, 23 cases (59%) were assessed as neurologically normal by PSOM, while 16 cases (41%) were assessed as neurologically abnormal. Among the 29 cases who completed the imaging review, magnetic resonance angiography (MRA) review in 23 cases indicated stability or improvement in the original arterial stenosis, with 6 cases experiencing transient worsening of arterial stenosis early in the disease course (within 2 months), which later improved. Arterial stenosis progression occurred in 6 cases at the final review of 29 cases who completed the imaging review, with 1 case developing progressive cerebral arteriopathy. The proportion of patients with headache, altered consciousness, and aphasia in the abnormal neurological function group, as well as the PedNISS scores at admission and discharge, were all higher than those in the normal neurological function group (all P<0.05). Univariate Logistic regression analysis revealed that only a PedNISS score>6 points at onset was an influencing factor for abnormal neurological function ( OR=20.58, 95% CI 3.93-107.70, P<0.001). Conclusions:Childhood FCA often presents with fluctuating onset, and the proximal segment of the middle cerebral artery is frequently affected. Progression of arterial stenosis is common within 2 months of the disease course, but clinical progression and new ischemic lesions are uncommon. Most patients have a favorable long-term prognosis. PedNIHSS score>6 points at admission is related to abnormal neurological function outcomes.

Objective:To investigate the risk factors and prognosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis following herpes simplex virus encephalitis (HSE) in children.Methods:A retrospective cohort study was conducted on 83 children with HSE hospitalized at Beijing Children′s Hospital, Capital Medical University, from January 2013 to June 2023. The clinical data, including demographics, clinical manifestations, Glasgow coma scale (GCS) scores, auxiliary examinations, and treatment regimens, were collected. The prognoses of these children were evaluated using the modified Rankin scale (mRS), pediatric cerebral performance category (PCPC) scale, and pediatric quality of life inventory (PedsQL). These children were divided into 2 groups: those who developed secondary anti-NMDAR encephalitis and those who did not. Non-parametric tests were used for intergroup comparisons, and Logistic regression models were applied to identify risk factors for secondary anti-NMDAR encephalitis.Results:Among the 83 children with HSE, 23 children developed secondary anti-NMDAR encephalitis. The secondary anti-NMDAR encephalitis group exhibited a later age of onset compared to the non-secondary group (4.0 (2.2, 7.1) vs. 1.6 (0.8, 5.4) years, Z=2.19, P=0.028), lower GCS scores (8.0 (5.5, 11.5) vs. 14.0 (9.8, 15.0) points, Z=3.74, P<0.001), and worse prognostic outcomes as measured by mRS, PCPC scale and PedsQL (3.0 (2.0, 5.0) vs. 1.0 (0.3, 3.0) points, 3.0 (2.0, 4.0) vs. 2.0 (1.0, 4.0) points, 52.0 (17.0, 67.0) vs. 86.5 (53.3, 97.5) points, Z=3.48, 3.36, 3.09, all P<0.01). Logistic regression analysis identified lower GCS scores during HSE as an independent risk factor for the secondary anti-NMDAR encephalitis ( OR=0.82, 95% CI 0.72-0.94, P=0.003). Conclusion:For the children with HSE who present low GCS scores, regular follow-ups are imperative in order to monitor for the potential development of anti-NMDAR encephalitis, thus facilitating early intervention and improving clinical outcomes.

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.

Objective:To summarize the long-term efficacy of nicotinamide in treating pediatric early-onset progressive encephalopathy with brain edema and (or) leukoencephalopathy-2 (PEBEL2) caused by NAXD gene variation .Methods:This was a case report conducted from February 2019 to January 2025. The long-term efficacy of nicotinamide was observed by following up a child with PEBEL2 who received the treatment in the Department of Neurology, Beijing Children′s Hospital Affiliated to Capital Medical University. The clinical data included changes in skin lesions, neurological symptoms. The modified Rankin scale (mRS) was used to evaluate the recovery of neurological function.Results:A boy was diagnosed with PEBEL2 caused by NAXD gene variation via genetic testing at Beijing Children′s Hospital Affiliated to Capital Medical University in February 2019, when he was 4 years and 6 months of age. Immediately after diagnosis, nicotinamide treatment was initiated at an initial dose of 100 mg/d, which was increased by 100 mg per week and gradually increased to 500 mg/d; meanwhile, other therapeutic drugs were gradually discontinued. After 1 year and 8 months of treatment, the child′s skin lesions had completely resolved; at the 2-year follow-up, dystonia in both upper limbs and swallowing dysfunction was alleviated significantly; by 2.5-year follow-up, his cognitive function also showed improvement. When the child was treated with 500 mg/d for 3 years, a rash appeared around the mouth. After the dose was reduced to 250 mg/d, the rash resolved, and the dose of 250 mg/d was maintained until the last follow-up. At the last follow-up in January 2025, the child was 10 years and 5 months of age. His mRS score decreased from 5 (before treatment) to 4. During the 6-year of continuous nicotinamide treatment, the child′s condition remained stable without progression. Drug-related skin rashes occurred, but no severe drug-related adverse reactions were observed.Conclusions:PEBEL2 is a treatable mitochondrial disease. Nicotinamide treatment can effectively improve skin lesions and neurological symptoms in PEBEL2 patients, and the long-term administration demonstrates a favorable safety profile.