Objective:To analyze the risk factors for children with severe community-acquired pneumonia (CAP) being admitted to the pediatric intensive care unit (PICU),and establish a clinical prediction model,then evaluate the clinical application value of this model.Methods:A retrospective analysis was performed on children diagnosed with severe CAP at the Children's Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University from January to June 2023.The children were divided into the PICU group and the non-PICU group based on whether they were admitted to PICU at admission.The differences in pediatric early warning score（PEWS），clinical characteristics，and laboratory test results between the two groups at their last visit before admission were compared. The independent risk factors for children with severe CAP admitted to PICU were analyzed,and a clinical prediction model was established,which was validated through the receiver operating characteristic (ROC) curve.Results:A total of 274 children were included,including 141 males and 133 females,with a median age of 50 (24,81) months. There were 43 cases in PICU group and 231 cases in non-PICU group.There were no statistically significant differences in gender and age between the two groups of children ( P>0.05). The PEWS score,white blood cell count,neutrophil count,neutrophil/lymphocyte ratio,procalcitonin (PCT),and lactate levels of children in the PICU group were significantly higher than those of children in the non-PICU group.While the duration of fever,peak temperature,and percutaneous arterial oxygen saturation (SpO 2) were significantly lower in the PICU group than those in the non-PICU group. All these differences were statistically significant ( P<0.05).Binary Logistic regression analysis showed that PEWS>4 points（ OR=6.583，95% CI 1.763 - 24.588， P<0.05），PCT>0.42 μg/L（ OR=19.046，95% CI 4.362-83.159， P<0.05），and SpO 2<93%（ OR=21.670，95% CI 3.843-122.184， P<0.05）were independent risk factors for children with severe CAP to be admitted to PICU.A clinical prediction model was constructed based on the above three independent risk factors.The area under ROC curve of the clinical prediction model was 0.941（95% CI 0.913-0.968， P<0.05），the sensitivity was 95.3%，the specificity was 80.5%，the positive predictive value was 83.0%，and the negative predictive value was 94.5%. Conclusion:For children with severe CAP，if they have PEWS > 4,an elevated PCT level，and a decreased SpO 2，it is recommended that they be admitted to PICU for further monitoring and treatment.The clinical prediction model for admission to the PICU for children with severe CAP，constructed by combining PEWS with commonly used clinical information in pediatric emergency，has a relatively high predictive efficacy and can provide a reference for the stratified diagnosis and treatment of children with severe CAP in the future.

BACKGROUND:Percutaneous kyphoplasty through a unilateral puncture approach is considered more effective than a bilateral puncture approach for the treatment of osteoporotic vertebral compression fractures.However,due to the unique anatomical shape and location of the L5 vertebral body,the traditional unilateral puncture approach has limited applicability in treating L5 osteoporotic vertebral compression fractures.To address this issue,we propose the use of the"O"point puncture approach.OBJECTIVE:To compare the effectiveness of percutaneous kyphoplasty via basal transversal process-posterior superior pedicle-lateral articular process intersection("O"point)with conventional approach percutaneous kyphoplasty in treating the L5 osteoporotic vertebral compression fractures.METHODS:A retrospective analysis was conducted on 54 patients with L5 osteoporotic vertebral compression fractures treated with traditional percutaneous kyphoplasty or percutaneous kyphoplasty via the"O"point approach between January 2020 and December 2022 at Affiliated Hospital of Southwest Medical University.According to the surgical method,the patients were divided into the"O"point approach group(group A,n=29)and the traditional approach group(group B,n=25).The position of the"O"point and iliac spine and puncture angle were measured by orthography before operation in group A.Cobb angle,anterior vertebral margin,middle height,and bone cement distribution were compared between the two groups prior to and 2 days after surgery,and during final follow-up.Pain relief and daily living ability were assessed using the visual analog scale and Oswestry disability index prior to and 2 days after surgery,and during final follow-up.Complications related to the surgery were recorded.RESULTS AND CONCLUSION:(1)Operative time and intraoperative fluoroscopy times were significantly shorter in group A than in group B(P＜0.05).However,no significant differences were observed in intraoperative blood loss or bone cement injection amounts between the two groups.(2)Both groups demonstrated significantly lower visual analog scale scores and Oswestry disability index on day 2 after surgery and at the last follow-up in comparison to before surgery.However,group A experienced a more noticeable decrease than group B(P＜0.05).(3)On both sides,the"O"point was located on average 1.23 cm below the highest point of the iliac spine line.The mean transverse distance between the"O"point and the iliac spine was 2.89 cm.(4)During the final follow-up,the Cobb angle of both groups exhibited significant improvements compared to their respective preoperative values(P＜0.05).However,there was no significant difference between the two groups(P＞0.05).(5)After operation,the distribution of bone cement was good in group A,accounting for 97％(28/29),and good in group B,accounting for 88％(22/25).Group A was significantly better than group B(P＜0.05).(6)The efficacy of percutaneous kyphoplasty utilizing the"O"point puncture technique on osteoporotic vertebral compression fractures of the L5 vertebra was superior to that of the traditional percutaneous kyphoplasty approach.However,the bone cement distribution achieved with percutaneous kyphoplasty via"O"point puncture was more satisfactory,and the puncture approach was able to circumvent the influence of a high iliac spine on the L5 vertebra.

BACKGROUND:Percutaneous kyphoplasty through a unilateral puncture approach is considered more effective than a bilateral puncture approach for the treatment of osteoporotic vertebral compression fractures.However,due to the unique anatomical shape and location of the L5 vertebral body,the traditional unilateral puncture approach has limited applicability in treating L5 osteoporotic vertebral compression fractures.To address this issue,we propose the use of the"O"point puncture approach.OBJECTIVE:To compare the effectiveness of percutaneous kyphoplasty via basal transversal process-posterior superior pedicle-lateral articular process intersection("O"point)with conventional approach percutaneous kyphoplasty in treating the L5 osteoporotic vertebral compression fractures.METHODS:A retrospective analysis was conducted on 54 patients with L5 osteoporotic vertebral compression fractures treated with traditional percutaneous kyphoplasty or percutaneous kyphoplasty via the"O"point approach between January 2020 and December 2022 at Affiliated Hospital of Southwest Medical University.According to the surgical method,the patients were divided into the"O"point approach group(group A,n=29)and the traditional approach group(group B,n=25).The position of the"O"point and iliac spine and puncture angle were measured by orthography before operation in group A.Cobb angle,anterior vertebral margin,middle height,and bone cement distribution were compared between the two groups prior to and 2 days after surgery,and during final follow-up.Pain relief and daily living ability were assessed using the visual analog scale and Oswestry disability index prior to and 2 days after surgery,and during final follow-up.Complications related to the surgery were recorded.RESULTS AND CONCLUSION:(1)Operative time and intraoperative fluoroscopy times were significantly shorter in group A than in group B(P＜0.05).However,no significant differences were observed in intraoperative blood loss or bone cement injection amounts between the two groups.(2)Both groups demonstrated significantly lower visual analog scale scores and Oswestry disability index on day 2 after surgery and at the last follow-up in comparison to before surgery.However,group A experienced a more noticeable decrease than group B(P＜0.05).(3)On both sides,the"O"point was located on average 1.23 cm below the highest point of the iliac spine line.The mean transverse distance between the"O"point and the iliac spine was 2.89 cm.(4)During the final follow-up,the Cobb angle of both groups exhibited significant improvements compared to their respective preoperative values(P＜0.05).However,there was no significant difference between the two groups(P＞0.05).(5)After operation,the distribution of bone cement was good in group A,accounting for 97％(28/29),and good in group B,accounting for 88％(22/25).Group A was significantly better than group B(P＜0.05).(6)The efficacy of percutaneous kyphoplasty utilizing the"O"point puncture technique on osteoporotic vertebral compression fractures of the L5 vertebra was superior to that of the traditional percutaneous kyphoplasty approach.However,the bone cement distribution achieved with percutaneous kyphoplasty via"O"point puncture was more satisfactory,and the puncture approach was able to circumvent the influence of a high iliac spine on the L5 vertebra.

Objective:To analyze the risk factors for children with severe community-acquired pneumonia (CAP) being admitted to the pediatric intensive care unit (PICU),and establish a clinical prediction model,then evaluate the clinical application value of this model.Methods:A retrospective analysis was performed on children diagnosed with severe CAP at the Children's Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University from January to June 2023.The children were divided into the PICU group and the non-PICU group based on whether they were admitted to PICU at admission.The differences in pediatric early warning score（PEWS），clinical characteristics，and laboratory test results between the two groups at their last visit before admission were compared. The independent risk factors for children with severe CAP admitted to PICU were analyzed,and a clinical prediction model was established,which was validated through the receiver operating characteristic (ROC) curve.Results:A total of 274 children were included,including 141 males and 133 females,with a median age of 50 (24,81) months. There were 43 cases in PICU group and 231 cases in non-PICU group.There were no statistically significant differences in gender and age between the two groups of children ( P>0.05). The PEWS score,white blood cell count,neutrophil count,neutrophil/lymphocyte ratio,procalcitonin (PCT),and lactate levels of children in the PICU group were significantly higher than those of children in the non-PICU group.While the duration of fever,peak temperature,and percutaneous arterial oxygen saturation (SpO 2) were significantly lower in the PICU group than those in the non-PICU group. All these differences were statistically significant ( P<0.05).Binary Logistic regression analysis showed that PEWS>4 points（ OR=6.583，95% CI 1.763 - 24.588， P<0.05），PCT>0.42 μg/L（ OR=19.046，95% CI 4.362-83.159， P<0.05），and SpO 2<93%（ OR=21.670，95% CI 3.843-122.184， P<0.05）were independent risk factors for children with severe CAP to be admitted to PICU.A clinical prediction model was constructed based on the above three independent risk factors.The area under ROC curve of the clinical prediction model was 0.941（95% CI 0.913-0.968， P<0.05），the sensitivity was 95.3%，the specificity was 80.5%，the positive predictive value was 83.0%，and the negative predictive value was 94.5%. Conclusion:For children with severe CAP，if they have PEWS > 4,an elevated PCT level，and a decreased SpO 2，it is recommended that they be admitted to PICU for further monitoring and treatment.The clinical prediction model for admission to the PICU for children with severe CAP，constructed by combining PEWS with commonly used clinical information in pediatric emergency，has a relatively high predictive efficacy and can provide a reference for the stratified diagnosis and treatment of children with severe CAP in the future.

Objective:To establish a decision tree model of pediatric complicated appendicitis (CA) based on Pediatric Appendicitis Score (PAS) combined with inflammatory indicators, and to evaluate its clinical application efficacy in pediatrics.Methods:The clinical data of 544 children diagnosed with appendicitis in Children′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 was retrospectively analyzed. According to postoperative pathology, the children were divided into uncomplicated appendicitis group and CA group. The independent risk factors of CA were screened by univariate and multivariate logistic regression analysis, and these parameters were included to establish the decision tree model. The accuracy of the decision tree model was verified by receiver operating characteristic (ROC) curve.Results:Binary logistic regression analysis indicated that the PAS, C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) were identified as independent risk factors for complicated appendicitis in children (all P<0.05). PAS, CRP and NLR were included as covariables to construct the decision tree model and binary logistic regression model for predicting CA. The decision tree demonstrated an overall accuracy of 79.2% with a sensitivity of 86.7% and specificity of 71.9%, and achieved an area under curve (AUC) of 0.821(95% CI: 0.786-0.857). The binary logistic regression model had a sensitivity of 79.6% and specificity of 69.1%, with an overall accuracy of 75.1% and achieved an AUC of 0.808(95% CI: 0.770-0.845). Conclusions:The decision tree model based on PAS score combined with CRP, NLR is a simple, intuitive and effective tool , which can provide pediatric emergency physicians a reliable basis for diagnosis of pediatric CA.

Objective:To retrospectively analyze the independent risk factors of complicated appendicitis(CA)in children under five years old and establish a clinical prediction model, and to evaluate the clinical application of this model.Methods:A retrospective analysis was performed on children under five years old who underwent appendectomy at Children′s Hospital of Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021.The children were divided into CA group and uncomplicated appendicitis group according to whether there was sign of perforation or gangrene in appendiceal tissue after operation.The differences in clinical features and preoperative laboratory test results between two groups were compared.The independent risk factors of CA were identified and a clinical prediction model was established.The clinical prediction model was verified by receiver operating characteristic curve.Results:A total of 140 children were enrolled in this study, including 84 cases in the CA group and 56 cases in uncomplicated appendicitis group.Univariate and binary Logistic regression analysis showed that the duration of symptoms>23.5 h( OR=6.650, 95% CI 2.469-17.912, P<0.05), abdominal muscle tension( OR=3.082, 95% CI 1.190-7.979, P<0.05) and C-reactive protein>41 mg/L ( OR=3.287, 95% CI 1.274-8.480, P<0.05) were independent risk factors for CA( P<0.05). The clinical prediction model of CA was constructed by the above mentioned three independent risk factors.The area under the receiver operating characteristic curve of the clinical prediction model was 0.881(95% CI 0.825-0.936), the sensitivity was 77.4%, the specificity was 87.5%, the positive predictive value was 91.3% and the negative predictive value was 70.0%. Conclusion:Acute appendicitis in children under five years old is more likely to progress to CA if the duration of symptoms>23.5 h, the level of C-reactive protein is increased, and the abdominal muscle tension is accompanied.The clinical prediction model of CA constructed by common clinical information in pediatric clinics has good prediction efficiency, which provides a simple and feasible reference method for clinicians to distinguish CA from uncomplicated appendicitis.

Objective : To investigate the effects of gestational diabetes mellitus (GDM) on birth outcome and umbilical artery (UA) blood flow parameters in the third trimester, and to analyze the role of UA blood flow parameters in GDM and birth outcome. Methods : Based on the birth cohort from Wuhu , Anhui , China , 189 pregnant women with GDM were collected as the case group. The non⁃GDM pregnant women were matched 1 ∶ 1 according to age and pre⁃pregnancy body mass index , and 189 normal pregnant women were selected as the control group. Pregnant women with GDM were divided into poorly controlled group and well controlled group according to fasting blood glucose in the third trimester. The UA blood flow parameters and fetal birth outcomes in the third trimester were tracked. Results : Compared with the control group , UA parameters in poorly controlled and well controlled groups significantly increased (F = 6. 63 , P < 0. 05 ; F = 4. 43 , P < 0. 05 ; F = 5. 57 , P < 0. 05) . Poor glycemic control of GDM was associated with increased birth weight and risk of larger than gestational age. The multi⁃factor linear regression model showed that the Z score of the peak systolic velocity/end diastolic velocity (S/D) in the poorly controlled group was negatively correlated with birth weight (β = - 209. 78 , 95% CI: - 301. 48 - 118. 07) . S/D index Z score mediated the relationship between poor blood glucose control and birth weight. The intermediate effect value was - 58. 41 (95% CI: - 106. 40 ~ - 19. 65) , accounting for 25. 98% of the total effect. Conclusion Poor glycemic control in GDM is a risk factor for fetal weight gain , and UA function plays a partial mediating role in influencing neonatal birth weight. GDM pregnant women should strictly control blood glucose level to better protect maternal and infant health.

Objective : To investigate the correlation between nocturnal sleep duration combined with snoring in the first trimester of pregnancyand small for gestational age(SGA) ，large for gestational age(LGA) ． Methods : Multi- variate Logistic regression model was used to analyze the association between nocturnal sleep duration ，snoring， their combined effects and SGA，LGA. Results : Compared to nocturnal sleep duration 7 to 9 h in the first trimester of pregnancy，sleep duration＜7 h was positively correlated with SGA in male newborn( OR = 4. 22，95% CI : 1. 69 - 10. 52) ; After stratified by snoring，the sleep duration of snoring women＜7 h was positively correlated with SGA ( OR = 5. 68，95% CI : 1. 02－31. 51) ，and the sleep duration of non-snoring women＜7 h was positively correlated with LGA ( OR = 2. 10，95% CI : 1. 16 －3. 81) ． Conclusion Sleep duration＜7 h in the first trimester of preg- nancy is a risk factor for SGA and LGA，and snoring may enhance the association between sleep duration＜7 h in the first trimester of pregnancy and SGA．Pregnant women should keep adequate nocturnal sleep duration to reduce the risk of abnormal neonatal weight.

Abstract Bisphenol A (BPA) is a high yield chemical and widely present in daily necessities and catering products. It is one of the environmental endocrine disruptors with estrogen like effects that may affect the immune system. This paper summarizes the most recent epidemiological studies on the relationship between BPA exposure and asthma in children at home and abroad, and briefly outlines the pathogenesis of BPA induced asthma in children, aiming to provide inspiration and directions for future research.

Objective: To understand the effect of pregnancyrelated anxiety on preschool childrens executive functions(EFs) and gender difference in order to optimize the early development environment of offspring life. Methods: This study was based on the ChinaAnhui Birth Cohort Study. Pregnant women from Maternal and Child Health Care Hospital in Maanshan, Anhui province between October 2008 and October 2010 were recruited. The general information of pregnant women and the pregnancyrelated anxiety were collected prospectively in the first trimester of pregnancy. A cohort of 3 556 children aged 3-5 were followed up and their basic characteristics were collected. Executive function of preschool children was assessed by Behavior Rating Inventory of Executive FunctionPreschool Version(BRIEF) (parent version). Results: In boys, compared with the control group, pregnancyrelated anxiety in the first trimester of pregnancy was associated with the risk of abnormality in working memory, planning/organization and GEC[OR(95%CI)=1.40(1.06-1.85), 1.64(1.06-2.54), 1.89(1.27-2.82)]. Anxiety in the both trimesters of pregnancy was associated with the risk of abnormality in inhibition, working memory, planning/organization and GEC[OR(95%CI)=2.60(1.45-4.67), 2.45(1.69-3.57), 2.23(1.28-3.88), 3.27(2.03-5.28)]. In girls, pregnancyrelated anxiety in the first trimester of pregnancy was associated with the risk of abnormality in inhibition and working memory[OR(95%CI)=1.79(1.13-2.83), 1.45(1.07-1.98)]. Anxiety in the third trimester of pregnancy was associated with the risk of abnormality in inhibition[OR(95%CI)=2.26(1.17-4.38)]. Anxiety in both trimesters of pregnancy was associated with the risk of abnormality in inhibition and working memory[OR(95%CI)=2.45(1.40-4.28), 2.02(1.35-3.01)]. Conclusion Pregnancyrelated anxiety significantly affected the executive function of preschool children, and there was a significant doseresponse relationship. Pregnancyrelated anxiety primarily affects working memory, planning/organization and GEC function in boys, and the working memory, inhibition function in girls.