To summarize rescuing and nursing experience of 3 ectopic pregnancy patients,suffering from severe toxicity caused by low-dose methotrexate(MTX)treatment.The key points include:constantly monitoring of patients for at least a week after MTX administration,and identifying MTX toxicity related symptoms as soon as possible;promptly establishing a multidisciplinary medical team to establish individualized rescue plans;quickly initiating the rescue therapy and implementing targeted fluid management to accelerate MTX excretion;intensifying protective isolation caring to prevent and control infection;applying refined safety management to prevent spontaneous bleeding;providing intensive caring of skin and mucosal toxicity symptoms to promote healing process;supplying individualized psychological counseling and support in time;strengthening the protection of the damaged organ.After emergent rescuing and intensive nursing,all 3 patients successfully recovered and were discharged from the hospital.

To summarize rescuing and nursing experience of 3 ectopic pregnancy patients,suffering from severe toxicity caused by low-dose methotrexate(MTX)treatment.The key points include:constantly monitoring of patients for at least a week after MTX administration,and identifying MTX toxicity related symptoms as soon as possible;promptly establishing a multidisciplinary medical team to establish individualized rescue plans;quickly initiating the rescue therapy and implementing targeted fluid management to accelerate MTX excretion;intensifying protective isolation caring to prevent and control infection;applying refined safety management to prevent spontaneous bleeding;providing intensive caring of skin and mucosal toxicity symptoms to promote healing process;supplying individualized psychological counseling and support in time;strengthening the protection of the damaged organ.After emergent rescuing and intensive nursing,all 3 patients successfully recovered and were discharged from the hospital.

Objective To explore the risk of preeclampsia(PE)and construct an individualized column chart predictive model.Methods A total of 209 PE patients admitted to Huzhou Maternal and Child Health Hospital from January 2020 to July 2023 were selected as research group,and 162 healthy pregnant women who underwent prenatal examination during the same period were selected as control group.Logistic regression model was used for data analysis,and nomogram prediction model based on Logistic regression results was constructed by R statistical software,receiver operating characteristic(ROC)curve and calibration curve were drawn,and Hosmer-Lemeshow goodness-of-fit test was conducted to evaluate prediction efficiency.Results The occurrence of PE had no correlation with body mass index(BMI),gestational age,pregnancy times,abortion history and whether there are multiple pregnancies(P＞0.05),but age,education level,gestational diabetes,gestational hypertension and standardized prenatal examination of pregnant women are related factors(P＜0.05).Age≥30 years old,education below senior high school,gestational diabetes,pregnancy-induced hypertension and irregular prenatal examination were risk factors for PE(P＜0.05).The area under ROC curve of nomograph model was 0.813(95％CI:0.770-0.855).Conclusion The nomogram model based on age,education level,diabetes in pregnancy,hypertension in pregnancy and irregular prenatal examination screened by Logistic regression model has a good predictive effect on the occurrence of PE.

Objective To explore the risk of preeclampsia(PE)and construct an individualized column chart predictive model.Methods A total of 209 PE patients admitted to Huzhou Maternal and Child Health Hospital from January 2020 to July 2023 were selected as research group,and 162 healthy pregnant women who underwent prenatal examination during the same period were selected as control group.Logistic regression model was used for data analysis,and nomogram prediction model based on Logistic regression results was constructed by R statistical software,receiver operating characteristic(ROC)curve and calibration curve were drawn,and Hosmer-Lemeshow goodness-of-fit test was conducted to evaluate prediction efficiency.Results The occurrence of PE had no correlation with body mass index(BMI),gestational age,pregnancy times,abortion history and whether there are multiple pregnancies(P＞0.05),but age,education level,gestational diabetes,gestational hypertension and standardized prenatal examination of pregnant women are related factors(P＜0.05).Age≥30 years old,education below senior high school,gestational diabetes,pregnancy-induced hypertension and irregular prenatal examination were risk factors for PE(P＜0.05).The area under ROC curve of nomograph model was 0.813(95％CI:0.770-0.855).Conclusion The nomogram model based on age,education level,diabetes in pregnancy,hypertension in pregnancy and irregular prenatal examination screened by Logistic regression model has a good predictive effect on the occurrence of PE.

Objective:To explore the influencing factors of fetal growth restriction (FGR) in patients with preeclampsia (PE) and construct a Nomogram prediction model.Methods:From Aug. 2021 to May. 2023, 273 PE patients admitted to our hospital were regarded as the study subjects, and grouped into a modeling group (n=191) and a validation group (n=82). Multivariate logistic regression analysis was applied to determine the influencing factors of FGR in PE patients. R4.3.1 was applied to construct a Nomogram model for predicting FGR in PE patients. Receiver operating characteristic (ROC) curve and the Hosmer Lemeshoe (H-L) goodness of fit test were applied to evaluate the discrimination and consistency of the Nomogram model in predicting FGR in PE patients.Results:There was no statistically obvious difference in gestational age, blood pressure, hemoglobin, urinary protein (UP), uric acid, umbilical artery systolic/diastolic blood pressure (S/D), D-dimer (D-D), or birth frequency between the modeling group and the validation group ( P>0.05). Compared with no concurrent FGR group, the onset of pregnancy in the concurrent FGR group was earlier, the levels of UP, S/D, and D-D, and the proportion of oligohydramnios were obviously higher, and the platelet count (PLT) was obviously lower ( t/χ 2=2.588, 1.437, 6.262, 5.464, 9.881, 3.326, P<0.05). Multivariate Logistic regression analysis showed that UP, S/D, D-D, and oligohydramnios were risk factors for FGR in PE patients ( OR=1.004, 3.807, 1.006, 4.348, P<0.05), while PLT was a protective factor ( OR=0.980, P<0.05). Nomogram model showed that when the total score of the above 5 influencing factors in PE patients was 149, the probability of concurrent FGR was 60%; when the total score was 167, the probability of concurrent FGR was 90%, and the probability of exceeding 167 was over 90%. Modeling group H-L test χ 2=6.736, P=0.565, validation group χ 2=5.812, P=0.668. The area under the ROC curve (AUC) of the modeling group and the validation group was 0.924 (95% CI: 0.883-0.965) and 0.932 (95% CI: 0.880-0.984), respectively. The sensitivity was 83.93% and 90.48%, and the specificity was 89.63% and 81.97%, respectively. Decision curve analysis (DCA) was applied to evaluate the clinical application value of the Nomogram model in predicting FGR in PE patients. Conclusion:The Nomogram model constructed based on the five indicators of UP, S/D, D-D, PLT, and oligohydramnios for predicting the risk of FGR in PE patients has high discrimination and consistency.

Objective:To explore the immunological characteristics of peripheral blood and genetic variations of 11 immunodeficiency virus(HIV)-negative children with Talaromyces marneffei(TM) infection, thus enhancing the diagnostic and therapeutic levels of TM infection in children. Methods:Clinical data of 11 HIV-negative children with TM infection who presented to Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from January 2010 to December 2022 were retrospectively analyzed, including clinical characteristics, peripheral immune profile and genetic test results.Results:A total of 11 HIV-negative children with TM infections were recruited, involving 9 males and 2 females with a median age of 19 months.The main clinical manifestations were fever (10/11, 90.91%), cough (10/11, 90.91%) and hepatomegaly (7/11, 63.64%). Common severe complications included acute respiratory distress syndrome (7/11, 63.64%) and septic shock (5/11, 45.45%). Finally, 2 children died.Transient neutropenia occurred in 6 cases (6/11, 54.55%), and lymphocytopenia combined with serum immunoglobulin (Ig) G decrease was observed in 4 cases (4/11, 36.36%). IgA decrease, IgM decrease, IgE decrease, IgM increase and IgE increase were observed in 6 cases, 3 cases, 5 cases, 3 cases, and 2 cases, respectively.Both T-lymphocyte and B-lymphocyte counts decreases was observed in 1 case.Genetic testing was performed in all recruited children, and genetic variations were detected in all of them.Inborn errors of immunity (IEIs) were diagnosed in 8 cases, including 4 diagnosed as CD 40 ligand deficiency with CD40LG variation, 1 of severe combined immunodeficiency with IL2RG variation, 1 of Signal transduction and activator of transcription 3(STAT3)-hyper-IgE syndrome with STAT3 variation and 1 of familial candidiasis type 2 with CARD9 compound heterozygous mutations.In the other 3 cases, 2 carried genetic variations that were likely pathogenic, and 1 case was considered uncertain. Conclusions:The clinical manifestations of HIV-negative children with TM infection are atypical, which is characterized as serious complications and high mortality.Early identification and gene testing to detect potential IEIs can improve the prognosis of TM infection.

Hyper-IgE syndrome (HIES) comprises a group of rare primary immunodeficiencies, which are characterized by extremely high serum IgE levels, eczema, recurrent skin and pulmonary infections.Signal transduction and activator of transcription 3( STAT3)-HIES is the most common type, which is caused by dominant-negative mutations in STAT3.STAT3-HIES confers broad innate and acquired immune defects, defects in skeletal, connective tissue, and vascular functions, causing a clinical phenotype including eczema, staphylococcal and fungal skin and pulmonary infections, scoliosis and minimal trauma fractures, vascular tortuosity and aneurysm.In this article, the advance in diverse clinical manifestations and management strategies of STAT3-HIES was summarized.

Adenovirus pneumonia is a common respiratory tract infection in children.Severe cases of adenovirus pneumonia have the characteristics of rapid onset, rapid progression and a panel of complications.Therefore, early recognition, diagnosis and treatment are particularly important.In recent years, studies on the pathogens, hosts, laboratory tests and biomarkers have provided new clinical clues for the early recognition and diagnosis of severe adenovirus pneumonia in children.There are currently no specific antiviral drugs for severe adenovirus pneumonia.Therefore, the main therapeutic strategies for adenovirus pneumonia are immune therapy and respiratory support.A large number of clinical studies have provided new ideas for standardizing therapeutic strategies and improving the prognosis of children.

Objective:To compare the efficacy and safety of insulin degludec and insulin glargine U100 in patients with type 2 diabetes mellitus.Methods:This study was a retrospective cohort study. The subjects were patients with type 2 diabetes mellitus who were hospitalized in 13 3A-level general hospitals in Shandong Province from September 2018 to December 2021. According to the type of basal insulin used, the patients were divided into insulin degludec group and insulin glargine U100 group. The basic information and laboratory test results in patients in the 2 groups were collected, the differences of fasting blood glucose level and incidence of hypoglycemia between the 2 groups were compared. The patients with complete blood glucose monitoring data in the 2 groups were selected and their blood glucose fluctuations were compared.Results:A total of 1 152 patients were entered in the study, including 552 patients in the insulin degludec group and 600 patients in the insulin glargine U100 group. The difference in the basic conditions in patients in the 2 groups was not statistically significant (all P>0.05). After treatment, the fasting blood glucose levels in patients in the 2 groups were lower than those before treatment, with statistically significant differences [10.2 (8.8, 12.5) mmol/L vs. 7.5 (6.6, 8.7) mmol/L, Z=-19.443, P<0.001; 10.0 (8.6, 11.7) mmol/L vs. 7.8 (6.6, 9.0) mmol/L, Z=-15.449, P<0.001], but the difference in fasting blood glucose levels between the 2 groups after treatment was not statistically significant ( Z=-1.427, P>0.05). The incidence of hypoglycemia in the insulin degludec group was lower than that in the insulin glargine U100 group [1.09% (6/552) vs. 2.83% (17/600), Z=4.481, P=0.032]. The intraday blood glucose standard deviation, maximum blood glucose fluctuation range, postprandial blood glucose fluctuation range, and average blood glucose fluctuation range in patients with complete blood glucose monitoring data in the insulin degludec group were significantly lower than those in the insulin glargine U100 group [(1.7±0.6) mmol/L vs. (2.4±1.0) mmol/L, (4.5±1.6) mmol/L vs. (6.7±2.9) mmol/L, (1.8±1.0) mmol/L vs. (3.3±1.2) mmol/L, (2.9±1.3) mmol/L vs. (4.6±2.1) mmol/L; all P<0.001]. Conclusion:The efficacy of insulin degludec in the treatment of type 2 diabetes mellitus is equivalent to that of insulin glargine U100, but the risk of hypoglycemia and blood glucose fluctuation is lower.

Objective:To compare the efficacy and safety of insulin degludec and insulin glargine U100 in patients with type 2 diabetes mellitus.Methods:This study was a retrospective cohort study. The subjects were patients with type 2 diabetes mellitus who were hospitalized in 13 3A-level general hospitals in Shandong Province from September 2018 to December 2021. According to the type of basal insulin used, the patients were divided into insulin degludec group and insulin glargine U100 group. The basic information and laboratory test results in patients in the 2 groups were collected, the differences of fasting blood glucose level and incidence of hypoglycemia between the 2 groups were compared. The patients with complete blood glucose monitoring data in the 2 groups were selected and their blood glucose fluctuations were compared.Results:A total of 1 152 patients were entered in the study, including 552 patients in the insulin degludec group and 600 patients in the insulin glargine U100 group. The difference in the basic conditions in patients in the 2 groups was not statistically significant (all P>0.05). After treatment, the fasting blood glucose levels in patients in the 2 groups were lower than those before treatment, with statistically significant differences [10.2 (8.8, 12.5) mmol/L vs. 7.5 (6.6, 8.7) mmol/L, Z=-19.443, P<0.001; 10.0 (8.6, 11.7) mmol/L vs. 7.8 (6.6, 9.0) mmol/L, Z=-15.449, P<0.001], but the difference in fasting blood glucose levels between the 2 groups after treatment was not statistically significant ( Z=-1.427, P>0.05). The incidence of hypoglycemia in the insulin degludec group was lower than that in the insulin glargine U100 group [1.09% (6/552) vs. 2.83% (17/600), Z=4.481, P=0.032]. The intraday blood glucose standard deviation, maximum blood glucose fluctuation range, postprandial blood glucose fluctuation range, and average blood glucose fluctuation range in patients with complete blood glucose monitoring data in the insulin degludec group were significantly lower than those in the insulin glargine U100 group [(1.7±0.6) mmol/L vs. (2.4±1.0) mmol/L, (4.5±1.6) mmol/L vs. (6.7±2.9) mmol/L, (1.8±1.0) mmol/L vs. (3.3±1.2) mmol/L, (2.9±1.3) mmol/L vs. (4.6±2.1) mmol/L; all P<0.001]. Conclusion:The efficacy of insulin degludec in the treatment of type 2 diabetes mellitus is equivalent to that of insulin glargine U100, but the risk of hypoglycemia and blood glucose fluctuation is lower.