Objective:To analyze the clinical characteristics of pulmonary mucormycosis (PM) in children with leukemia, and explore its diagnosis and treatment strategies and prognosis.Methods:In this case-series study, the clinical data of 19 children who were diagnosed with leukemia complicated by PM at the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2024 were retrospectively analyzed.Their gender, age, type of leukemia, clinical manifestations, chest CT findings, bronchoscopy results, etiology, treatment regimens, and prognosis were summarized.The patients were divided into a survival group and a death group.The clinical data were compared between the 2 groups.Categorical variables were compared using the Fisher′s exact test, and continuous variables were compared using the Wilcoxon rank-sum test.Results:A total of 19 children aged 2 to 17 years with leukemia complicated by PM were involved, including 9 boys and 10 girls, with most cases (15 cases) occurring in the autumn and winter.The median time from the first leukemia chemotherapy to infection with mucor was 1 month.Clinical manifestations mainly included fever (100%), cough (94.7%), hemoptysis (42.1%), and pneumothorax (21.1%).Chest CT findings primarily showed extensive lung consolidation (84.2%), pleural effusion (84.2%), pulmonary nodules (78.9%), halo signs (73.7%), cavitation (36.8%), crescent signs (26.3%), and reverse halo signs (21.1%).Fourteen children underwent bronchoscopy, which primarily revealed tracheal obstruction, pale or congested mucosa, mucosal edema, mucosal necrosis, bronchial stenosis, and bronchial cavitary fistulas.Mucor was detected using various methods including metagenomic next-generation sequencing (mNGS), cultures, and lung tissue microscopy.Patients were mainly treated with intravenous administration of Amphotericin B in different formulations combined with oral Posaconazole.Three patients also underwent surgical resection of the affected lung lobe in addition to medical treatment.After treatment, 14 patients had a good prognosis, while 5 patients died.The causes of death were massive hemoptysis in 2 cases, severe respiratory failure in 1 case, and treatment withdrawn due to critical condition in 2 cases.There were no statistically significant differences in age, gender, type of leukemia, whether to undergo bronchoscopy and surgery, time from the first chemotherapy to onset of infection, presence of comorbid infection, chest CT characteristics, and time to start treatment between survival and death groups(all P>0.05). Conclusions:There is no specificity in clinical manifestations of leukemia complicated by PM, which, however, still exhibits some characteristics.mNGS plays a crucial role in early diagnosis.Intravenous administration of Amphotericin B combined with oral Posaconazole and surgical intervention are an effective treatment regimen.

Objective:To analyze the clinical characteristics of pulmonary mucormycosis (PM) in children with leukemia, and explore its diagnosis and treatment strategies and prognosis.Methods:In this case-series study, the clinical data of 19 children who were diagnosed with leukemia complicated by PM at the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2024 were retrospectively analyzed.Their gender, age, type of leukemia, clinical manifestations, chest CT findings, bronchoscopy results, etiology, treatment regimens, and prognosis were summarized.The patients were divided into a survival group and a death group.The clinical data were compared between the 2 groups.Categorical variables were compared using the Fisher′s exact test, and continuous variables were compared using the Wilcoxon rank-sum test.Results:A total of 19 children aged 2 to 17 years with leukemia complicated by PM were involved, including 9 boys and 10 girls, with most cases (15 cases) occurring in the autumn and winter.The median time from the first leukemia chemotherapy to infection with mucor was 1 month.Clinical manifestations mainly included fever (100%), cough (94.7%), hemoptysis (42.1%), and pneumothorax (21.1%).Chest CT findings primarily showed extensive lung consolidation (84.2%), pleural effusion (84.2%), pulmonary nodules (78.9%), halo signs (73.7%), cavitation (36.8%), crescent signs (26.3%), and reverse halo signs (21.1%).Fourteen children underwent bronchoscopy, which primarily revealed tracheal obstruction, pale or congested mucosa, mucosal edema, mucosal necrosis, bronchial stenosis, and bronchial cavitary fistulas.Mucor was detected using various methods including metagenomic next-generation sequencing (mNGS), cultures, and lung tissue microscopy.Patients were mainly treated with intravenous administration of Amphotericin B in different formulations combined with oral Posaconazole.Three patients also underwent surgical resection of the affected lung lobe in addition to medical treatment.After treatment, 14 patients had a good prognosis, while 5 patients died.The causes of death were massive hemoptysis in 2 cases, severe respiratory failure in 1 case, and treatment withdrawn due to critical condition in 2 cases.There were no statistically significant differences in age, gender, type of leukemia, whether to undergo bronchoscopy and surgery, time from the first chemotherapy to onset of infection, presence of comorbid infection, chest CT characteristics, and time to start treatment between survival and death groups(all P>0.05). Conclusions:There is no specificity in clinical manifestations of leukemia complicated by PM, which, however, still exhibits some characteristics.mNGS plays a crucial role in early diagnosis.Intravenous administration of Amphotericin B combined with oral Posaconazole and surgical intervention are an effective treatment regimen.

Objective:To summarize the clinical features, diagnosis and treatment of erythema multiforme caused by Mycoplasma pneumoniae infection.Methods:The data of clinical features, treatment and prognosis of children diagnosed with erythema multiforme caused by Mycoplasma pneumoniae infection and treated in the First Affiliated Hospital of Zhengzhou University from Jane 2016 to December 2019 were retrospectively analyzed, and related literature was summarized.Results:All the 3 patients suffered from fever, cutaneous and mucous membrane lesions.Cutaneous lesions were manifested as exudative erythema multiforme, and the mucous membranes involved included oral mucosa, ocular conjunctiva and genital mucosa.The symptoms in all 3 cases were alleviated after the treatment with glucocor-ticoid, high doses of gamma globulin, anti-Mycoplasma pneumoniae and symptomatic support.Two children suffered secondary infection during treatment and improved with anti-infection.Neither patients had sequelae during the follow-up.Conclusions:Mycoplasma pneumoniae can cause erythema multiforme in children, but it is always misdiagnosed due to its clinical rarity.The mechanism of erythema multiforme caused by Mycoplasma pneumoniae infection is not clear.Early administration of glucocorticoid and high doses of gamma globulin, anti-Mycoplasma pneumoniae and symptomatic support often lead to a good prognosis.

Objective To investigate the relationship between adipose tissue insulin resistance and subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes mellitus. Methods The clinical data of 102 patients with newly diagnosed type 2 diabetes mellitus from March 2012 to March 2013 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. According to the carotid artery intima media thickness (cIMT) by ultrasonography, the patients were divided into cIMT thickening group (cIMT ≥0.9 mm, 44 cases) and cIMT normal group (cIMT＜0.9 mm, 58 cases). The fasting insulin (FINS), free fatty acids (FFA), fasting blood glucose (FBG) and blood lipids were measured, and the adipose tissue insulin resistance index (Adipo-IR) and homeostatic model assessment insulin resistance index (HOMA-IR) were calculated. Results The cIMT of 102 patients with newly diagnosed type 2 diabetic mellitus was (0.85 ± 0.15) mm. The age, triglyceride, FFA, HOMA-IR and Adipo-IR in cIMT thickening group were significantly higher than those in cIMT normal group:(50.82 ± 12.45) years vs. (41.41 ± 10.61) years, (2.43 ± 0.78) mmol/L vs. (2.14 ± 0.70) mmol/L, (0.58 ± 0.09) mmol/L vs. (0.48 ± 0.10) mmol/L, 5.57 ± 2.88 vs. 4.11 ± 1.93 and 8.39 ± 3.72 vs. 5.69 ± 3.05, and there were statistical differences (P＜0.01 or＜0.05). Logistic regression analysis result showed that cIMT thickening was independently associated with age and Adipo-IR in patients with newly diagnosed type 2 diabetes mellitus ( OR=1.119 and 1.473, P=0.002 and 0.003, 95% CI 1.041 to 1.201 and 1.144 to 1.895). Conclusions Adipose tissue insulin resistance is an independent risk factor for subclinical atherosclerosis in patients with newly diagnosed type 2 diabetic mellitus.

Objective To investigate association of pancreatic fat content and lipid levels in individuals with newly diagnosed type 2 diabetes.Methods Fifty four subjects with newly diagnosed type 2 diabetes and 22 volunteers without type 2 diabetes were enrolled in this study.Pancreatic fat content was determined with magnetic resonance imaging.Lipid levels were measured.Results The pancreatic fat content in patients with newly diagnosed type 2 diabetes and control subjects was (17.13 ± 10.35) ％ and (11.62 ±7.15)％, respectively (P =0.025).Median pancreatic fat content of subjects with newly diagnosed type 2 diabetes correlated negatively with total cholesterol level (r =-0.361, P =0.007) and triglycerides level (r =-0.346, P =0.010).Conclusions Increased levels of serum total cholesterol and low density lipoprotein cholesterol might relieve the extent of pancreatic fat content.

Objective To evaluate whether dynamic contrast enhanced-MRI (DCE-MRI) can help clinicians in differentiating malignant tumors from benign lesions and in predicting and correlating the histologic grade for breast cancer patients.Methods DCE-MRI from 98 patients (with histopathological confirmation) in our department were retrospectively analyzed.In the first dynamic phase,the hot and cold spot ROIs were selected as the regions with maximum and minimum Slopein,respectively.The kinetic characteristics (including hot spot,cold spot,and heterogeneous characteristics) and morphologic features were evaluated.The ROC curve analysis was used to test the diagnostic power of all DCE-MRI parameters (inflow slope,Slopein ; washout slope; inflow slope ratio; washout slope ratio; time-signal intensity curve shape; rim enhancement; internal homogeneity) for differentiating malignant tumors from benign breast lesions.Joncheere-Terpstra test was adopted to analyze the kinetic data.Categorical data were analyzed by using the Fisher test.Results Hot spot Slopein might have the biggest area (0.620) under the ROC curve (but not significant) among all the different MRI parameters(P ＞ 0.05).Its sensitivity,specificity,positive predictive value,negative predictive value were 63.2％ (55/87) and 72.7％ (8/11),respectively.The cold spot parameter Slopein(P =0.025),heterogeneity parameter ratio-in (P =0.031),and internal homogeneity (P =0.032) showed a significant correlation with histologic grade.The median and quartile of cold spot Slopein in pathologic Ⅰ,Ⅱ,and Ⅲ were 6.1 × 10-3,5.4 × 10-3 and 1.4 × 10-3,respectively;inflow slope ratio:6.6,9.8 and 17.6 ; pathologic Ⅰ,Ⅱ,and Ⅲ showed 2,1,and 0 patients with homogeneity enhancement,respectively ; intermediate enhancement:5,12,and 2 patients,respectively;heterogeneity enhancement:2,6,and 8 patients.Conclusions The DCE-MRI is a potential tool in helping clinicians to predict the histologic grading in breast cancers.Parameter hot spot Slopein might help differentiae malignant tumors from the benign counterpart.

With the increasing incidences of pancreatic diseases and the rapid development in techniques of magnetic resonance imaging (MRI) lately, superiorities of MRI are obvious. This article reviewed MRI depictions of pancreatic diseases, their values in diagnosis and differential diagnosis, and clinical application of MRI in this field.

Objective To study the value of magnetic resonance cholangiopancreatography(MRCP) in diagnosing chronic pancreatitis(CP) and pancreatic cancer(PC).Methods MRCP findings in 31 cases of CP and 31 cases of PC were analyzed.Results MRCP characteristics in CP group included :(1) irregular dilatation of the pancreatic duct(87.1%),might across the whole segment of the lesion(93.5%);(2)dilatation of bile duct less(29%);tapering(48.4%) or normal(48.4%) or abrupt interruption(3.2%);(3)stones within the pancreatic duct(25.8%),pseudocyst(29%).MRCP characteristics in PC group included:(1)double-duct sign(67.7%);(2)continuous and smooth dilatation of the pancreatic duct distal to tumor(61.3%),abrupt interruption at the site of the tumor(74.2%);(3)more percentage of bile duct dilatation(74.2%),abrupt interruption of common bile duct at site of tumor(71%).Conclusion MRCP characteristics are of vital importance in differenntial diagnosing CP and PC.