Objective:To summarize the clinical features of children with anomalous origin of coronary artery (AOCA) who received extracorporeal membrane oxygenation (ECMO) support.Methods:A case series study was conducted. Clinical data was collected from 6 children who were diagnosed with AOCA by coronary computed tomography angiography or digital subtraction angiography and received ECMO support in the Pediatric Intensive Care Unit of Henan Provincial People′s Hospital between January 2020 and August 2024. Descriptive analysis was performed on their clinical features, laboratory test results, point-of-care echocardiography results, imaging findings, surgical management, and outcomes.Results:Among the 6 children (3 males and 3 females), the age of onset was 12.5 (11.0, 13.0) years. All 6 patients were transported from other hospitals under ECMO support. Five patients were admitted with chief complaints of "cardiac arrest after strenuous activity, syncope after strenuous activity, or heart failure" and were initially diagnosed with fulminant myocarditis or cardiomyopathy. All 6 children had significantly elevated troponin and B-type natriuretic peptide levels upon admission. Point-of-care echocardiography revealed segmental left ventricular systolic dysfunction in all 6 children, and AOCA was detected in 2 cases based on bedside ultrasound. ECMO was successfully weaned in 5 children. All 6 cases were diagnosed with AOCA. Four children underwent surgical coronary artery correction, one received a heart transplantation, and one missed the optimal window for surgical correction. Heart transplantation was recommended for the latter, but the parents declined, and the patient was discharged. During the follow-up until August 2025, all 6 children survived.Conclusions:AOCA in children is prone to misdiagnosis as other diseases in the early stage. Timely ECMO support provides the possibility of surgery or heart transplantation for children experiencing acute ischemic and hypoxic episodes due to AOCA, improving survival rates.

Objective:To summarize the clinical features of children with anomalous origin of coronary artery (AOCA) who received extracorporeal membrane oxygenation (ECMO) support.Methods:A case series study was conducted. Clinical data was collected from 6 children who were diagnosed with AOCA by coronary computed tomography angiography or digital subtraction angiography and received ECMO support in the Pediatric Intensive Care Unit of Henan Provincial People′s Hospital between January 2020 and August 2024. Descriptive analysis was performed on their clinical features, laboratory test results, point-of-care echocardiography results, imaging findings, surgical management, and outcomes.Results:Among the 6 children (3 males and 3 females), the age of onset was 12.5 (11.0, 13.0) years. All 6 patients were transported from other hospitals under ECMO support. Five patients were admitted with chief complaints of "cardiac arrest after strenuous activity, syncope after strenuous activity, or heart failure" and were initially diagnosed with fulminant myocarditis or cardiomyopathy. All 6 children had significantly elevated troponin and B-type natriuretic peptide levels upon admission. Point-of-care echocardiography revealed segmental left ventricular systolic dysfunction in all 6 children, and AOCA was detected in 2 cases based on bedside ultrasound. ECMO was successfully weaned in 5 children. All 6 cases were diagnosed with AOCA. Four children underwent surgical coronary artery correction, one received a heart transplantation, and one missed the optimal window for surgical correction. Heart transplantation was recommended for the latter, but the parents declined, and the patient was discharged. During the follow-up until August 2025, all 6 children survived.Conclusions:AOCA in children is prone to misdiagnosis as other diseases in the early stage. Timely ECMO support provides the possibility of surgery or heart transplantation for children experiencing acute ischemic and hypoxic episodes due to AOCA, improving survival rates.

The rapid development of artificial intelligence (AI), especially generative AI (GenAI), has already brought, and will continue to bring, revolutionary changes to our daily production and life, as well as create new opportunities and challenges for diagnostic and therapeutic practices in the medical field. Haihe Hospital of Tianjin University collaborates with the National Supercomputer Center in Tianjin, Tianjin University, and other institutions to carry out research in areas such as smart healthcare, smart services, and smart management. We have conducted research and development of a full-process disease diagnosis and treatment assistance system based on GenAI in the field of smart healthcare. The development of this project is of great significance. The first goal is to upgrade and transform the hospital's information center, organically integrate it with existing information systems, and provide the necessary computing power storage support for intelligent services within the hospital. We have implemented the localized deployment of three models: Tianhe "Tianyuan", WiNGPT, and DeepSeek. The second is to create a digital avatar of the chief physician/chief physician's voice and image by integrating multimodal intelligent interaction technology. With generative intelligence as the core, this solution provides patients with a visual medical interaction solution. The third is to achieve deep adaptation between generative intelligence and the entire process of patient medical treatment. In this project, we have developed assistant tools such as intelligent inquiry, intelligent diagnosis and recognition, intelligent treatment plan generation, and intelligent assisted medical record generation to improve the safety, quality, and efficiency of the diagnosis and treatment process. This study introduces the content of a full-process disease diagnosis and treatment assistance system, aiming to provide references and insights for the digital transformation of the healthcare industry.
Artificial Intelligence ; Humans ; Delivery of Health Care ; Generative Artificial Intelligence

Community acquired pneumonia(CAP)has a high morbidity and mortality rate, and can bring a heavy social and economic burden.Its etiology is complex.How to identify high-risk children, early diagnosis, prognosis prediction are the focus of clinical research.Early identification and active intervention of high-risk children who need hospitalization or admission to pediatric intensive care unit by using score scales and biomarkers are crucial to improve the survival rate.This review summarized the assessment of severity and prognosis of CAP in children by different score scales and biomarkers.

Objective:To explore the relationship between different admission sources and outcomes at children in pediatric intensive care unit(PICU).Methods:The clinical data of children admitted to PICU of Henan Provincial People′s Hospital from January 1, 2021 to December 31, 2021 were collected.The children were divided into emergency group, outpatient group, ward transfer group and out-hospital transfer group according to different admission sources, and the influence of different admission sources on the outcome of children was analyzed.Results:A total of 413 children were included in the study.There were 141 cases(34.14%)in emergency group, 14 cases(3.39%)in outpatient group, 115 cases(27.85%)in ward transfer group and 143 cases(34.62%)in out-hospital transfer group.There were significant differences among the four groups in terms of age, length of hospital stay, PCIS score, type of disease, duration of mechanical ventilation and outcome of children( P<0.05). There was no significant difference in gender among the four groups( P=0.328). Among the 143 children of out-hospital transfer group, 92 cases(64.3%)were admitted during the day and 51 cases(35.7%)were admitted in the night.There was no significant difference in age, gender, duration of mechanical ventilation, PCIS score, length of hospital stay and outcome of children between two groups( P>0.05). The independent risk factors for mortality of children in out-hospital transfer group were length of hospital stay( OR=0.717, 95% CI 0.582-0.883, P=0.002), gender( OR=13.185, 95% CI 2.044-85.061, P=0.007), duration of mechanical ventilation>1 day( OR=23.524, 95% CI 3.294-168.026, P=0.002)and PCIS score≤80( OR=6.000, 95% CI 1.637-21.985, P=0.007). Conclusion:PICU children in our hospital mainly come from emergency, ward transfer and out-hospital transfer.The patients transferred from other hospitals were the most critically ill and had the worst outcome, suggesting that we need to develop and popularize referral standards for critically ill children and establish a transport system so that children can receive timely referral and effective treatment, so as to reduce the risk of death of referred children as far as possible.

Objective:To measure the predictive value of miR-424 on the risk of sepsis complicated with acute respiratory distress syndrome(ARDS), and to explore its correlation with the prognosis of ARDS children.Methods:A prospective study was conducted.The data of children with sepsis (some complicated with ARDS), who were treated in Henan Provincial People′s Hospital (People′s Hospital, Zhengzhou University) were collected from February 2020 to February 2021.The incidence of ARDS and the fatality rate of ARDS children were recorded.Children were divided into survival group and death group according to whether death or not.The expression of miR-424 in peripheral blood mononuclear cells was detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR). Pearson correlation analysis was made to investigate the relationship between the expression level of miR-424 and Pediatric Critical Illness Score(PCIS), Sequential Organ Failure Assessment(SOFA) score, oxygenation index(P/F ratio), C-reactive protein(CRP), procalcitonin (PCT), interleukin 6 (IL-6) and interleukin 8 (IL-8). The factors affecting the prognosis of ARDS children were analyzed by multivariate Logistic regression.Receiver operating characteristic curve(ROC)was used to assess the accuracy of miR-424 in early diagnosis of sepsis complicated with ARDS, and to measure the predicative value of miR-424 on the risk of death in sepsis patients with ARDS. Results:A total of 121 sepsis patients were included in this study, and 36 cases of them were complicated with ARDS.The expression level of miR-424(0.56±0.17)in the blood of sepsis patients complicated with ARDS was significantly lower than that of sepsis patients without ARDS (0.98±0.26)( t=8.776, P<0.001). The expression of miR-424 was negatively co-rrelated with IL-6( r=-0.627, P<0.01), IL-8 ( r=-0.651, P<0.01) and CRP( r=-0.472, P<0.05)in sepsis patients with ARDS.The expression of miR-424 was positively correlated with PCIS score( r=0.330, P<0.05), P/F ratio ( r=0.592, P<0.001) and albumin ( r=0.496, P<0.05) in sepsis patients with ARDS.The ROC showed that miR-424 [area under curve(AUC)=0.908, 95% CI: 0.856-0.960] could differentiate sepsis patients with ARDS from those without ARDS.Compared with that of the survival group(0.63±0.15), miR-424 of the death group decreased significantly(0.42±0.14)( t=3.890, P<0.05). The decreased miR-424 (AUC=0.845, 95% CI: 0.696-0.995)indicated an increased risk of death in children with ARDS.Multivariate Logistic regression analysis showed that miR-424( OR=0.001, P=0.033)and albumin ( OR=0.553, P=0.040) were independent risk factors for death in ARDS children. Conclusions:miR-424 can help with early diagnosis of sepsis complicated with ARDS, and can be used as a predictor of the prognosis of sepsis children complicated with ARDS.

Regulatory B cells(Breg) are a subgroup of B lymphocytes and characterized by their immunosuppressive capacity. The regulation of immune response by Breg plays a critical role in the mouse and human immune systems. Previous studies on Breg mainly focus on autoimmune diseases and tumors, but in recent years, the role of Breg in chronic infectious diseases has attracted attention. This review summarized the phenotypes, modes of action and the role of Breg in the process of chronic infectious diseases aiming to provide a new sight for research on immunotherapy for chronic infectious diseases.

Objective:To explore the risk factors for mortality in pediatric acute respiratory distress syndrome (PARDS) requiring extracorporeal membrane oxygenation (ECMO) support.Methods:Clinical data of 109 patients with severe PARDS supported by ECMO, who were hospitalized in 6 ECMO centers in China from September 2012 to February 2020, were retrospectively analyzed. They were divided into survival group and death group according to the prognosis. Chi-square test and rank sum test were used to compare the variables between the two groups, including the demographic data, laboratory examination results, clinical data before and after ECMO, and other supportive treatment. Univariate and multivariate Logistic regression models were used to analyze the prognostic risk factors.Results:In these 109 cases, 54 died and 55 survived. Compared with the survival group, the death group had higher incidences of acute kidney injury (AKI) (48.1% (26/54) vs. 21.8% (12/55) , χ2=8.318, P=0.004) and coagulation dysfunction (22.2% (12/54) vs. 7.3% (4/55) , χ2=4.862, P=0.027), and higher rate of renal replacement therapy (48.1% (26/54) vs. 21.8% (12/55) , χ2=9.694, P=0.008) during ECMO support. Logistic regression analysis showed that continuous renal replacement therapy (CRRT) and AKI were independent risk factors for death in patients with severe PARDS requiring ECMO support ( HR=3.88,95% CI 1.04-14.52, HR=4.84,95% CI 1.21-19.46, both P<0.05). Conclusion:AKI and CRRT are independent risk factors for predicting mortality in patients with severe PARDS requiring ECMO support.

Objective:To analyze clinical factors related to nosocomial infection in children with extracorporeal membrane oxygenation(ECMO)support.Methods:General data, infection data and relevant factors in children with ECMO support in Bayi Children′s Hospital, the 7 th Medical Center of People′s Liberation Army General Hospital and Henan Provincial People′s Hospital from September 2012 to February 2020 were reviewed.Relevant factors of nosocomial infection in them were analyzed. Results:Among 163 cases, 36(22.1%) children supported with ECMO had infections during the period of ECMO, and 72 pathogenic microorganisms were detected, including 67 bacteria (33 Acinetobacter baumannii, 21 Klebsiella pneumoniae, and 6 Pseudomonas aeruginosa) and 5 fungi.Pathogens from the respiratory system, blood system, urinary tract and abdominal cavity were detected in 45 cases(62.5%), 25 cases (34.7%), 1 case (1.4%), and 1 case (1.4%), respectively.Drug sensitivity analysis of the Acinetobacter baumannii showed that it was the extensively resistant strain.Compared with uninfected children supported with ECMO, ECMO support time[(10.0±6.7) d], hospitalization[(34.0±25.3) d], hospitalization cost[(234 368±113 234) yuan], preoperative oxygenation index(52.8±23.0) and lactate value[(9.6±5.9) mmol/L]were significantly higher in nosocomial infection ones[(4.6±3.2) d, (24.3±19.8) d, (161 416±65 847) yuan, 35.6±10.4, (5.6±5.4) mmol/L] supported with ECMO (all P<0.05). There was no significant difference in the mortality between 2 groups ( P>0.05). In addition, lactate level (9.8 mmol/L) and oxygenation index (36.0±12.7) were significantly higher in died children(2.7 mmol/L, 22.1±10.4) with nosocomial infection during the period of ECMO support than those of survivors (all P<0.05). Multivariate Logistic regression analysis showed that ECMO support time( OR=7.054, 95% CI: 2.206-25.525) and preoperative lactate value( OR=2.250, 95% CI: 1.378-4.611) were independent risk factors of nosocomial infection. Conclusions:Correcting underlying diseases of ECMO supporting and shortening the duration of ECMO can reduce the incidence and mortality of nosocomial infection in children who are supported with ECMO.

Objective:To investigate the relationship between the serum high mobility group box 1 (HMGB1) level and children with febrile convulsion(FC) and epileptic seizures in the future.Methods:A total of 359 children with first-episode FC occurring in January 2014 to January 2017 admitted to the Department of Pediatrics, Henan Provincial People′s Hospital, were enrolled in the FC group.One hundred children without FC were enrolled in the fever control group, and 100 healthy children were enrolled in the healthy control group.Children with FC were followed for 18 months and their seizures were recorded.Serum HMGB1 and inflammatory response indexes were measured in all subjects, and the diagnostic value of HMGB1 for FC was analyzed.Other data were used to analyze the correlation between HMGB1 and the conversion of FC into epilepsy.Results:The level of serum HMGB1 in the FC group were hig-her than those in the healthy control group and the fever control group, and the differences were statistically significant [(3.04±1.01) μg/L, (5.09±1.45) μg/L vs.(8.32±2.27) μg/L, all P<0.01]. serum HMGB1 level in children with FC was positively correlated with interleukin(IL)-1β, IL-6, tumor necrosis factor (TNF)-α, C-reactive protein (CRP) and white blood cell (WBC) ( r=0.364, 0.173, 0.227, 0.235, 0.247, all P<0.05). There were significant differences in HMGB1 levels between groups with different duration and types of convulsions [(8.11±2.15) μg/L vs.(10.19±2.51) μg/L, (7.63±1.93) μg/L vs.(9.83±2.25) μg/L, all P<0.05]; HMGB1 level diagnosis of FC was better [area under the receiver′s operating characteristic curve (AUC)=0.843 (95% CI: 0.811-0.873)]; Serum HMGB1 in children with epilepsy with FC was higher than that without conversion to epilepsy, and the difference was statistically significant [(8.18±2.14) μg/L vs.(8.95±2.73) μg/L, P<0.05]; However, its performance in predicting the conversion of FC to epilepsy was not high [AUC=0.596 (95% CI: 0.544-0.691)]; Multivariate regression analysis showed that it was not an independent influencing factor of FC to epilepsy [odd ratio( OR)=1.929, P=0.222]. Conclusions:Serum HMGB1 levels in children with FC are related to the onset, severity and type of fever, and are one of the influencing factors affecting the conversion of FC to epilepsy, but not the independent factors.