This study analyzed the epidemiological characteristics and trends of respiratory syncytial virus (RSV) infections among inpatients with acute respiratory infections (ARI) in a children′s hospital in Shenzhen City inpatients from 2020 to 2023. From January 2020 to December 2023, multiple reverse transcription polymerase chain reaction (RT-PCR) combined with capillary electrophoresis fragment analysis technology was used to detect the nucleic acids of 12 respiratory pathogens, including RSV, in hospitalized children diagnosed with ARI. The patients were divided into six age groups: 0 to <6 months, 6 months to <1 year, 1 to <2 years, 2 to <5 years, 5 to <10 years, and 10 to <18 years. A total of 53 033 children were tested, including 6 830 RSV positive cases, with an overall positivity rate of 12.88%. The annual RSV positivity rates from 2020 to 2023 were 20.04%, 16.18%, 4.89%, and 13.33%, respectively, with statistically significant differences between the years ( χ2=1 185.994, P<0.001). The positive rate of RSV detection decreased with increasing age across all years (all P trend<0.05). From 2020 to 2023, the proportion of RSV-positive cases aged 2 to 5 years and older showed an increasing trend ( P trend<0.001 for all years). Compared to 2023, the median age of RSV-infected children was lower in 2020 ( Z=7.826, P<0.001) and 2021 ( Z=6.106, P<0.001). The proportion of severe infections requiring ICU admission did not change significantly across all years ( χ2=0.179, P=0.981). The RSV epidemic season in 2020 mainly occurred during 28-43 weeks, and in 2021, it spanned from 22-43 weeks. However, in 2022, the season was delayed until the 49th week and lasted for three weeks. In 2023, the seasonal epidemic appeared earlier, starting in the 14th week and lasting for 28 weeks. From 2020 to 2023, the rate of RSV co-infections with other pathogens (mycoplasma pneumoniae, human parainfluenza virus, human bocavirus, human coronavirus, human metapneumovirus, and influenza A) significantly increased (all P trend<0.01). In conclusion, the epidemiological characteristics of RSV infections in Shenzhen Children′s Hospital changed from 2020 to 2023. In 2022, there were only delayed, low-intensity and short-lived seasonal epidemics. However, in 2023, there was an earlier and prolonged epidemic, with increased infections in children aged 2 to 5 years and older and a rise in co-infections, while the proportion of severe infections requiring ICU admission remained unchanged.

Peritoneal dialysis (PD) is a crucial renal replacement therapy for end-stage renal disease (ESRD), offering significant advantages as high flexibility, hemodynamic stability, and high cost-effectiveness. However, prolonged exposure to intra-abdominal dialysate may predispose to the mechanical complication of abdominal external hernia. Abdominal external hernia may lead to various adverse clinical outcomes. In severe cases, it can progress to incarceration or even rupture, ultimately necessitating discontinuation of the therapy. The authors systematically review PD-associated abdominal external hernias, including their clinical landscape, risk factors, surgical treatment strategies and prognostic determinants. They also assess the effects of hernia repair on residual renal function, aiming to provide references for clinical decision-making.

This study analyzed the epidemiological characteristics and trends of respiratory syncytial virus (RSV) infections among inpatients with acute respiratory infections (ARI) in a children′s hospital in Shenzhen City inpatients from 2020 to 2023. From January 2020 to December 2023, multiple reverse transcription polymerase chain reaction (RT-PCR) combined with capillary electrophoresis fragment analysis technology was used to detect the nucleic acids of 12 respiratory pathogens, including RSV, in hospitalized children diagnosed with ARI. The patients were divided into six age groups: 0 to <6 months, 6 months to <1 year, 1 to <2 years, 2 to <5 years, 5 to <10 years, and 10 to <18 years. A total of 53 033 children were tested, including 6 830 RSV positive cases, with an overall positivity rate of 12.88%. The annual RSV positivity rates from 2020 to 2023 were 20.04%, 16.18%, 4.89%, and 13.33%, respectively, with statistically significant differences between the years ( χ2=1 185.994, P<0.001). The positive rate of RSV detection decreased with increasing age across all years (all P trend<0.05). From 2020 to 2023, the proportion of RSV-positive cases aged 2 to 5 years and older showed an increasing trend ( P trend<0.001 for all years). Compared to 2023, the median age of RSV-infected children was lower in 2020 ( Z=7.826, P<0.001) and 2021 ( Z=6.106, P<0.001). The proportion of severe infections requiring ICU admission did not change significantly across all years ( χ2=0.179, P=0.981). The RSV epidemic season in 2020 mainly occurred during 28-43 weeks, and in 2021, it spanned from 22-43 weeks. However, in 2022, the season was delayed until the 49th week and lasted for three weeks. In 2023, the seasonal epidemic appeared earlier, starting in the 14th week and lasting for 28 weeks. From 2020 to 2023, the rate of RSV co-infections with other pathogens (mycoplasma pneumoniae, human parainfluenza virus, human bocavirus, human coronavirus, human metapneumovirus, and influenza A) significantly increased (all P trend<0.01). In conclusion, the epidemiological characteristics of RSV infections in Shenzhen Children′s Hospital changed from 2020 to 2023. In 2022, there were only delayed, low-intensity and short-lived seasonal epidemics. However, in 2023, there was an earlier and prolonged epidemic, with increased infections in children aged 2 to 5 years and older and a rise in co-infections, while the proportion of severe infections requiring ICU admission remained unchanged.

Peritoneal dialysis (PD) is a crucial renal replacement therapy for end-stage renal disease (ESRD), offering significant advantages as high flexibility, hemodynamic stability, and high cost-effectiveness. However, prolonged exposure to intra-abdominal dialysate may predispose to the mechanical complication of abdominal external hernia. Abdominal external hernia may lead to various adverse clinical outcomes. In severe cases, it can progress to incarceration or even rupture, ultimately necessitating discontinuation of the therapy. The authors systematically review PD-associated abdominal external hernias, including their clinical landscape, risk factors, surgical treatment strategies and prognostic determinants. They also assess the effects of hernia repair on residual renal function, aiming to provide references for clinical decision-making.

Objective To investigate the value of magnetic resonance imaging-proton density fat fraction(MRI-PDFF)in evaluating hepatic steatosis in patients with chronic hepatitis B virus(HBV)infection.Methods The patients,aged>16 years,who visited the outpatient service or were hospitalized in Beijing Tsinghua Changgung Hospital from January 2018 to December 2022 and were diagnosed with chronic HBV infection were enrolled,and all patients underwent MRI examination of the liver in our hospital.The patients were divided into groups based on the presence or absence of liver cirrhosis,and the consistency in PDFF between different hepatic segments was compared between groups.The Kappa consistency test and intraclass correlation coefficient(ICC)were used for consistency analysis.Results A total of 76 patients treated with nucleoside analogues were enrolled,among whom 23(30.26％)had liver cirrhosis.For all patients,the simple arithmetic average of PDFF fluctuated between 1.49％and 30.93％.According to MRI-PDFF≥5％as the diagnostic criterion for fatty liver disease,there were 29 patients(38.16％)with fatty liver disease among all patients.For all 76 patients,the simple arithmetic average of PDFF was lower than the weighted average of PDFF for the whole liver,and there was no significant difference between the simple arithmetic average of PDFF,the weighted average of PDFF,and the PDFF values of the left and right lobes of the liver(F=0.39,P=0.76).The consistency test showed that the PDFF values of each hepatic segment and the left and right lobes of the liver had strong consistency with the weighted average and simple arithmetic average of PDFF,with an ICC of>0.75,but the consistency between the PDFF value of the right lobe and the weighted average of PDFF was higher than that between the PDFF value of the left lobe and the weighted average of PDFF.In the consistency test of differentiating fatty liver disease in patients with liver cirrhosis,there was poor consistency between the PDFF value of segment Ⅶ and the weighted average of PDFF(Kappa=0.39),with moderate consistency for the left lobe and the Ⅰ,Ⅱ,Ⅲ,Ⅴ,Ⅵ,and Ⅷ segments.For the patients with liver cirrhosis,the lowest consistency was observed between the PDFF value of Ⅶ segment and the weighted average of PDFF for the whole liver,and the highest consistency was observed between the PDFF value of Ⅵ segment and the weighted average of PDFF for the whole liver.For the patients without liver cirrhosis,the lowest consistency was observed between the PDFF value of Ⅱ segment and the weighted average of PDFF for the whole liver,and the highest consistency was observed between the PDFF value of Ⅴ segment and the weighted average of PDFF for the whole liver.Conclusion MRI-PDFF is more comprehensive in evaluating hepatic steatosis in patients with chronic HBV infection,and for the patients with liver cirrhosis,there is poor consistency between the PDFF value of each segment and the weighted average of PDFF.

Acute necrotizing encephalopathy (ANE) is a subtype of acute encephalopathy presented with disturbance of consciousness and symmetric bilateral thalamic necrosis in neuroradiology.Patients with ANE had a high mortality or severe neurological sequela.ANE usually secondary to virus infectious disease, in which influenza is a common etiology.During the 3 years of the worldwide pandemic of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection, ANE has become a severe complication and cause of death in children, which has aroused much concern.Here is a review of the research progress of epidemiology, pathogenesis, diagnosis, treatments and prognosis of ANE, in order to improve the knowledge of clinicians on this disease.

Cystic fibrosis (CF) is a multisystem disease caused by CFTR gene mutations, affecting the lungs, digestive system, and reproductive tract.Infectious lung disease is the major cause of exacerbation and mortality in most patients.There are specific pathogen spectrums in infectious lung disease and antibiotics application principles in CF patients.In this article, the application of antibiotics in clinical guidelines for care of children with CF in Royal Brompton Hospital (2020) was introduced.

Objective:To investigate the feasibility of nebulizing injectable Tobramycin for the treatment of Pseudomonas aeruginosa (Pa) in pediatric cystic fibrosis (CF) patients. Methods:The clinical data of 3 CF children with Pa infection who were treated by nebulizing injectable Tobramycin in Shenzhen Children′s Hospital from September 2017 to March 2021 were retrospectively analyzed.The efficacy and safety were explored.The nebulized injectable Tobramycin (160 mg/dose) was given twice daily after airway clearance.After one-month treatment course, oral Ciprofloxacin would be given [30 mg/(kg·d)] to patients for another 1 month if Pa was still positive in repeat sputum cultures.Results:There were 2 males and 1 female in 3 cases recruited.The youngest patient was 1-year-old when receiving Tobramycin treatment.After airway clearance and inhalation of injectable Tobramycin, all had improvements in respiratory symptoms and chest CT scan.Two cases took additional oral Ciprofloxacin as Pa was still positive after the 1-month treatment course of Tobramycin.Pa turned to negative in all 3 cases after treatment for 3 months to 1.5 years.Besides, after treatment all the 3 patients had normal liver and renal functions, and normal hearing in multiple follow ups.One patient had a normal brainstem auditory evoked potential in the reexamination.Conclusions:Nebulizing injectable Tobramycin would be a reasonable alternative to inhaled Tobramycin solution for treating pediatric CF patients with Pa in view of the present condition in mainland China.However, it is still worth further study and discussion.

Objective:To investigate the etiological characteristics and changes of plastic bronchitis(PB)in children from 2010 to 2019 at Shenzhen Children′s Hospital, and provide reference basis for improving the understanding of PB etiology.Methods:The clinical data of children diagnosed with infectious-associated PB at Shenzhen Children′s Hospital from Jan 2010 to Dec 2019 were retrospectively analyzed, and the etiological characteristics and changes were summarized.Results:There were 94 cases of mycoplasma pneumoniae, 38 cases of influenza virus, 41 cases of adenovirus, 16 cases of mixed infection, 11 cases of bacteria, and 57 cases of unclear etiology in 266 infectious-associated PB children.The distribution of PB in each age group: 15 cases were infants, 63 cases were toddlers, 112 cases were preschoolers, and 76 cases were school-age children.Adenovirus was the main pathogen of PB in infants and toddlers(60.0%, 28.6%), and mycoplasma pneumoniae(34.8%, 60.5%) as well as influenza virus(13.4%, 22.4%) were the main pathogen in preschool and school-age children, with statistically significant difference( P<0.001). From 2010 to 2019, the annual positive rates of pathogens were 62.5%, 60.0%, 66.7%, 74.1%, 64.0%, 50.0%, 93.3%, 57.1%, 75.0%, and 84.7%, respectively.PB was caused by mycoplasma pneumoniae infection every year.From 2016 to 2019, PB caused by mycoplasma pneumoniae infection increased year by year, while PB caused by adenovirus infection increased every other year. Conclusion:Mycoplasma pneumoniae was the most common pathogen of PB, followed by adenoviruses and influenza viruses, while bacteria, fungi and other viruses were relatively rare.In the infant group, adenovirus infection was predominant, while in preschool and school-age children group, mycoplasma pneumoniae and influenza virus infection were predominant.

Objective:To summarize the clinical characteristics of adenovirus (HAdVs) pneumonia in children.Methods:The clinical manifestations, laboratory results, imaging features and treatment courses of 541 children with HAdVs pneumonia treated in Shenzhen Children′s Hospital from January 2017 to August 2019 were retrospectively studied.Results:The number of children diagnosed with HAdVs pneumonia increased year by year.A total of 541 patients were included in this study (214 females and 327 males, median age 31 months). The majority of patients (89.3%, 483/541 cases) were less than 6 years of age.Cough (98.3%, 532/541 cases) was the most common symptom, followed by fever (93.7%, 507/541 cases), tachypnea (36.6%, 198/541 cases) and wheeting (32.5%, 176/541 cases). Thirteen point three percent patients (72/541 cases) had existing primary diseases.Severe HAdVs pneumonia was observed in 33.8% of patients (183/541 cases), the most common intrapulmonary complication were pleural effusion(18.6%, 101/541 cases) and respiratory failure (7.0%, 38/541 cases). In co-infection cases, 46.9% of the patients (254/541 cases) suffered from co-infection with mycoplasma pneumoniae, 21.6% of the patients (117/541 cases) suffered from bacterial co-infection.Ninety-eight point five percent of the patients (533/541 cases) were cured, and 1.5% of the patients (8/541 cases) died or discharged voluntarily.Convulsions [ P=0.026, OR=7.312 (95% CI: 1.267-42.191)] and bacterial co-infections [ P=0.030, OR=2.724 (95% CI: 1.101-6.741)] were independently correlated with the occurrence of severe HAdVs pneumonia. Conclusions:Pre-school aged children are at higher risks of developing HAdVs pneumonia.The majority of patients presents with fever and cough as primary manifestations.Tachypnea and wheezing are also common clinical features of HAdVs pneumonia patients.Approximately a third of children with HAdVs pneumonia may develop into severe pneumonia.The presentation of convulsion and the exis-tence of bacterial co-infections may help to predict the development of severe HAdVs pneumonia in pediatric patients.