Objective To construct a clinical-radiological nomo-gram model for severe mycoplasma pneumoniae pneumonia coinfec-tion with other pathogens(Co-SMPP)in children.Methods The clinical and radiological data of children with severe mycoplasma pneumoniae pneumonia(SMPP)who underwent nucleic acid testing or bronchoalveolar lavage(BAL)were analyzed retrospectively.The data analysis were performed by using SPSS 27.0 software.The group comparison between simple SMPP and Co-SMPP children was conducted by using t-tests,Mann-Whitney U tests,or chi-square tests.Nomogram analysis was performed by using R software and rms packages.The predictive performance of the model was evaluated by using the receiver operating characteristic(ROC)curve.Results A total of 194 SMPP children were included in the study,including 136 cases(70.1％)with simple SMPP,58 cases(29.9％)with Co-SMPP.The fibrinogen and albumin levels were lower in Co-SMPP children[(3.53±0.85)g/L,41.00(39.03,43.68)g/L]than in simple SMPP children[(3.79±0.80)g/L,42.80(41.00,44.40)g/L],with P values of 0.047 and 0.036,respec-tively.The probability of bronchial stenosis and grid shadow were higher in Co-SMPP children than in simple SMPP children,and there were significant differences between the two groups(P＜0.001,P=0.010).The odds ratio of bronchial stenosis in predicting Co-SMPP children was 14.085.The clinical-radiological nomogram model had an area under the curve(AUC)of 0.840,with sensi-tivity and specificity of 0.756 and 0.848,respectively.Conclusion The nomogram model based on clinical-radiological features can effectively predict Co-SMPP.

Objective To observe the value of neurite orientation dispersion and density imaging(NODDI)for diagnosing unilateral temporal lobe epilepsy(TLE)complicated with hippocampal sclerosis(HS)(TLE-HS).Methods Brain diffusion kurtosis imaging(DKI),3D T1WI and 3D fluid attenuated inversion recovery(FLAIR)sequence images were prospectively collected in 55 patients with unilateral TLE-HS(TLE-HS group)and 55 healthy controls(HC group),and NODDI parameter maps were acquired.The hippocampus NODDI parameters values and FLAIR signal intensity were compared among the affected side,the healthy side in TLE-HS group and HC group,as well as between each two,and their value for diagnosing unilateral TLE-HS were analyzed.Results Significant differences of hippocampus intracellular volume fraction(ICVF),isotropic volume fraction(ISOVF),orientation dispersion index(ODI)values and FLAIR signal intensity were found among the affected side,the healthy side in TLE-HS group and HC group(all P＜0.05).There were significant differences of ICVF,ISOVF and ODI values between the affected side and the healthy side in TLE-HS group(all P＜0.05),of ICVF,ISOVF,ODI values and FLAIR signal intensity between the affected side in TLE-HS group and HC group(all P＜0.05),and of ISOVF values and FLAIR signal intensity between the healthy side in TLE-HS group and HC group(both P＜0.05).The area under the curve(AUC)of ICVF,ISOVF,ODI and their combination for differentiating the affected side and the healthy side of TLE-HS was 0.913,0.712,0.912 and 0.964,for differentiating the affected side of TLE-HS and HC was 0.940,0.822,0.871 and 0.971,respectively,and the combination both had the highest AUC(both P＜0.05).The AUC of ISOVF,ODI and their combination for differentiating the healthy side of TLE-HS and HC was 0.666,0.630 and 0.744,respectively,being not significant different(all P＞0.05).The AUC of FLAIR signal intensity for differentiating the affected side and the healthy side of TLE-HS,the affected side of TLE-HS and HC,the healthy side of TLE-HS and HC was 0.627,0.756 and 0.653,respectively.Conclusion Bilateral hippocampus NODDI parameters were helpful for diagnosing unilateral TLE-HS,which might be superior to commonly used FLAIR sequence.

Objective To observe the value of neurite orientation dispersion and density imaging(NODDI)for diagnosing unilateral temporal lobe epilepsy(TLE)complicated with hippocampal sclerosis(HS)(TLE-HS).Methods Brain diffusion kurtosis imaging(DKI),3D T1WI and 3D fluid attenuated inversion recovery(FLAIR)sequence images were prospectively collected in 55 patients with unilateral TLE-HS(TLE-HS group)and 55 healthy controls(HC group),and NODDI parameter maps were acquired.The hippocampus NODDI parameters values and FLAIR signal intensity were compared among the affected side,the healthy side in TLE-HS group and HC group,as well as between each two,and their value for diagnosing unilateral TLE-HS were analyzed.Results Significant differences of hippocampus intracellular volume fraction(ICVF),isotropic volume fraction(ISOVF),orientation dispersion index(ODI)values and FLAIR signal intensity were found among the affected side,the healthy side in TLE-HS group and HC group(all P＜0.05).There were significant differences of ICVF,ISOVF and ODI values between the affected side and the healthy side in TLE-HS group(all P＜0.05),of ICVF,ISOVF,ODI values and FLAIR signal intensity between the affected side in TLE-HS group and HC group(all P＜0.05),and of ISOVF values and FLAIR signal intensity between the healthy side in TLE-HS group and HC group(both P＜0.05).The area under the curve(AUC)of ICVF,ISOVF,ODI and their combination for differentiating the affected side and the healthy side of TLE-HS was 0.913,0.712,0.912 and 0.964,for differentiating the affected side of TLE-HS and HC was 0.940,0.822,0.871 and 0.971,respectively,and the combination both had the highest AUC(both P＜0.05).The AUC of ISOVF,ODI and their combination for differentiating the healthy side of TLE-HS and HC was 0.666,0.630 and 0.744,respectively,being not significant different(all P＞0.05).The AUC of FLAIR signal intensity for differentiating the affected side and the healthy side of TLE-HS,the affected side of TLE-HS and HC,the healthy side of TLE-HS and HC was 0.627,0.756 and 0.653,respectively.Conclusion Bilateral hippocampus NODDI parameters were helpful for diagnosing unilateral TLE-HS,which might be superior to commonly used FLAIR sequence.

Objective To construct a clinical-radiological nomo-gram model for severe mycoplasma pneumoniae pneumonia coinfec-tion with other pathogens(Co-SMPP)in children.Methods The clinical and radiological data of children with severe mycoplasma pneumoniae pneumonia(SMPP)who underwent nucleic acid testing or bronchoalveolar lavage(BAL)were analyzed retrospectively.The data analysis were performed by using SPSS 27.0 software.The group comparison between simple SMPP and Co-SMPP children was conducted by using t-tests,Mann-Whitney U tests,or chi-square tests.Nomogram analysis was performed by using R software and rms packages.The predictive performance of the model was evaluated by using the receiver operating characteristic(ROC)curve.Results A total of 194 SMPP children were included in the study,including 136 cases(70.1％)with simple SMPP,58 cases(29.9％)with Co-SMPP.The fibrinogen and albumin levels were lower in Co-SMPP children[(3.53±0.85)g/L,41.00(39.03,43.68)g/L]than in simple SMPP children[(3.79±0.80)g/L,42.80(41.00,44.40)g/L],with P values of 0.047 and 0.036,respec-tively.The probability of bronchial stenosis and grid shadow were higher in Co-SMPP children than in simple SMPP children,and there were significant differences between the two groups(P＜0.001,P=0.010).The odds ratio of bronchial stenosis in predicting Co-SMPP children was 14.085.The clinical-radiological nomogram model had an area under the curve(AUC)of 0.840,with sensi-tivity and specificity of 0.756 and 0.848,respectively.Conclusion The nomogram model based on clinical-radiological features can effectively predict Co-SMPP.

Objective:To investigate the clinical characteristics, diagnosis and treatment status, and existing problems of early infantile epileptic encephalopathy type 2 (EIEE2) caused by de novoa mutation of cyclin-dependent kinase-like 5 gene (CDKL5).Methods:The medical history, auxiliary examination and diagnosis and treatment characteristics of 1 case with EIEE2 caused by de novoa mutation of CDKL5 gene in neonatal department of Children′s Hospital of Nanjing Medical University on August 12, 2019 were retrospectively analyzed.Combined with relevant literatures, the clinical diagnosis and treatment ideas and future prospects of this disease were summarized.Results:The patient was a female child with the age of 13 days and 23 hours.The main clinical manifestation was recurrent convulsion which was not alleviated significantly after using antiepileptic drug.The second-generation sequencing detected c. 119C>T/ p. A40V heterozygous mutation of CDKL5 gene, which was de novo mutation.Conclusions:EIEE2 caused by de novoa mutation of CDKL5 gene is a rare disease worthy of attention.Early detection and genetic diagnosis are the key to improve the diagnosis and treatment rate.

Patent ductus arteriosus (PDA) is a common disease of premature.The complications of symptomatic patent ductus arteriosus(sPDA) include respiratory disorders,intraventricular hemorrhage,necrotizing enterocolitis,pulmonary hemorrhage,bronchopulmonary dysplasia,retinopathy,death,etc.This review aims to introduce typical clinical manifestations of sPDA,specific echocardiography performance,new inspection methods and PDA scores for prognosis.

Objective To assess the radiological imaging findings of hepatic inflammatory myofibroblastic tumor and to discuss the appropriate morphological classification.Methods A total of 22 patients with hepatic inflammatory myofibroblastic tumor confirmed by pathology were enrolled.Imaging performance of hepatic inflammatory myofibroblastic tumor were analyzed and the lesions were classified into appropriate type based on the imaging findings.Results Totally 23 lesions were found in 22 patients.The typical imaging features included great enhancement at later phase (13/20),moth eat en central necrosis (12/23) and peripheral shell (12/23).Seed in fruit was the most typical classification (8/23),followed by Seedless fruit (7/23).Conclusion Hepatic inflammatory myofibroblastic tumur typically shows as a single nodular lesion with moth eaten necrosis and peripheral shell like a Seed in fruit.The enhancement at later phase (especially the peripheral enhancement) can be regarded as a particular feature.

Hepatocellular carcinoma ( HCC ) is one of the commonest malignant tumors in China .The therapeutic effects of conventional therapies including surgery resection at early stage ,chemotherapy or radiothera-py are greatly less than expected .One of the most possible reasons is the blockage of apoptosis in HCC cells .This review collects literatures about the studies on the roles of key signal pathways including RA ,STAT3,PDT,p53,β-catenin,TRAIL,microRNA and RAS in HCC therapy .This study may contribute greatly to providing outline in-sights for using apoptosis induction in liver cancer therapy .We hope it can promote the development liver cancer therapy in China .

Objective To investigate the association of tumor necrosis factor-alpha (TNF-α) gene promoter region - 1031T/C and its combination with interleukin-6 (IL-6 ) gene promoter region -634C/G single nucleotide polymorphisms (SNP) with the genetic susceptibility to endometriosis.Methods Total of 432 endometriosis patients and 499 non-endometriosis women who had received an operation due to tubal ligation,tubal recanalization,laparoscopic hydrotubation,ovarian simple cyst and teratoma were collected and separated into endometriosis group and control group,that all cases were confirmed by operation and pathology.A case-control study was performed in endometriosis and control group to evaluate the association of these SNP with the susceptibility to endometriosis by using a fluorescent quantitative PCR-based high resolution melting ( HRM ) method.Results ( 1 ) TNF-α - 1031T/C genotype:the T and C of TNF-α - 1031T/C allele frequencies in the endometriosis group and control group were 79.2％ (684/864),20.8％ (180/864) and 81.8％ (816/998),18.2％ (182/998),respectively.The TT,TC and CC of TNF-α - 1031T/C genotype frequencies in the two groups were 63.7％ (275/432),31.0％ ( 134/432 ),5.3％ (23/432) and 66.5％ (332/499),30.5％ (152/499),3.0％ ( 15/499),respectively.There were no statistical significances in the TNF-α - 1031T/C alleles and genotypes distributions between the two groups ( P =0.158,P =0.186 ).( 2 ) TNF-α - 1031T/C and IL-6 - 634C/G conjoint genotypes:to research on the TNF-α - 1031T/C and IL-6 -634C/G genotypes for conjoint analysis,the TT + CC,TC + CC,CC +CC,TT + CG,TC + CG,CC + CG,TT + GG,TC + GG and CC + GG combination genotype frequencies in the two groups were 39.4％ ( 170/432 ),19.4％ ( 84/432 ),4.6％ ( 20/432 ),20.6％ ( 89/432 ),8.8％ (38/432),0.9％ (4/432),3.5％ (15/432),2.3％ (10/432),0.5％ (2/432) and 36.7％ ( 183/499),17.4％(87/499),1.4％ (7/499),26.1％ (130/499),10.4％ (52/499),1.2％ (6/499),3.8％ (19/499),2.6％ ( 13/499),0.4％ (2/499),respectively.There were no statistical significances in the combination genotypes distributions between the two groups ( P =0.107 ).As compared with carriers of TT + CC combination genotype,the endometriosis risk of carriers of CC + CC combination genotype enhanced 3.076 times ( 95％ CI:1.268 - 7.457,P =0.009 ),and the endometriosis risk of carriers of other combination genotypes were no statistical significances (all P ＞ 0.05 ).ConclusionsThe study demonstrates that there are no significant association between the SNP of TNF-α - 1031T/C and genetic susceptibility to endometriosis.However the results indicate that there are significant association betweengenetic susceptibility to endometriosis and the combination polymorphisms of TNF-α -1031T/C and IL-6- 634C/G.

Objective This study aimed to investigate the incidence and the cause for duodenalbiliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct Methods After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct Before stent placement, the routine laboratory studies including leukocyte, neutrophil percentage and the levels of total bilirubin and direct bilirubin in blood were performed for all patients. Two to five days [ an average of (3.3 ±0. 9) days ] after stent implantation, the above indexes were tested again, and 1 ml of water containing 185 MBq of 99Tcm-DTPA was given orally before extubation, then 99Tcm radioactivity in the bile was detected 2 hours later. For the measurement data obtained from the experiment, t test or Wilcoxon signed rank test was adopted to compare them, and P ＜ 0. 05 was considered to be statistically different Results In 14 cases, radioactivity was successfully detected in the bile 2-5 days after stent implantation. Twelve of them was detected to have radioactivity in the bile 2 hours before extubation with duodenal-biliary reflux. The technetium count in the bile accounted for 1.82% of the total intake dose. There was no radioactivity in the bile in 2 cases. In 14 patients, there were no symptoms of cholangitis such as high fever, chills, increased jaundice, and so on after stent implantation. The mean of white blood cell count was (7.59 t2. 62) × 109/L, and the median of neutrophil percentage was 0. 74. Compared with those before stent implantation, the difference did not reach statistical significance ( t = 0. 423, Z = 1. 036, P ＞ 0. 05 ).After stent implantation, the median of total bilirubin and direct bilirubin were significantly lower, which were 92. 2 and 74. 3 μmol/L. Compared with those before stenting,the difference was statistically significant (Z= -3. 170, -3. 170, P ＜0.05). Conclusions There is a high incidence of duodenal-biliary reflux after stent implantation in distal common bile duct in the early stage. However, there is no simultaneous cholangitis caused by duodenal-biliary reflux.