Objective: To analyze the characteristics of pediatric pesticide poisoning cases admitted to a children s hospital in Jiangxi Province, so as to provide references for the prevention and treatment of pediatric pesticide poisoning. Methods: Medical records of 349 pesticide poisoning hospitalized cases from 2009 to 2023 in a children s hospital in Jiangxi Province were retrospectively reviewed to summarized clinical features, categories of pesticides involved, therapeutic interventions, and prognostic outcomes. Results: Among the cases of pesticide poisoning in children, there were 217 boys and 132 girls with an average age of 4 years and 8 months; 35.82% of cases occurred during April-June, followed by 27.22% during July-September, during October-December accounting for 22.35%, with 14.61% during January-March. There were 75 (21.49%), 148 (42.41%), 126 cases ( 36.10% ) during 2009-2013, 2014-2018, 2019-2023. In terms of pesticide type, insecticides ranked first (166 cases, 47.56% ), followed by herbicides (116 cases, 33.24%) and rodenticides (58 cases, 16.62%). The average hospitalization time was 4 days, and a total of 73 cases (20.92%) required admission to the intensive care unit among pesticide poisoning cases. There were 11 deaths, including 6 cases who were associated with paraguat esposure of paraquat. Self poisoning accounted for 34 cases, with an average age of 12 years and 2 months; 50.00% (17 cases) were concentrated in 2022-2023, accounting for 64.71% (22 cases) in girls; 8 cases of self poisoning resulted in death, accounting for 72.73% of the total number of deaths. Conclusions The period of April to June repesents the peak time for pediatric pesticide poisoning cases, and the proportion of accidental ingestion is relatively high. It is necessary to strictly prevent child poisoning.

Objective:To analyze the relationship between clinical symptoms，BIG score，laboratory examination and the prognosis of children with moderate to severe traumatic brain injury (TBI)，to determine the indicators associated with poor prognosis，in order to make early judgment for the prognosis of children with moderate to severe TBI.Methods:A total of 78 children with moderate to severe TBI were enrolled in the PICU of Jiangxi Provincial Children's Hospital from January 2022 to January 2023. Clinical data，laboratory tests，BIG scores and Glasgow prognostic score were collected upon admission. The patients were followed up for 6 months and divided into poor prognosis group（Glasgow prognostic score1-3）and good prognosis group（Glasgow prognostic score4-5）based on the Glasgow prognostic score. The indicators related to poor prognosis were selected，and the efficacy of the indicators to predict the prognosis was analyzed and compared.Results:There were statistical differences among BIG score，hemoglobin，lactic acid，glucose，respiratory failure，and hypotension shock（ P<0.05）. The BIG score was an independent risk factor for a poor prognosis. The BIG score had the highest AUC value（0.820）among the four indices. The combined indices（BIG score，hemoglobin，lactic acid，glucose）had the highest AUC value（0.851）and had better performance for predicting the prognosis of moderate to severe TBI in children than any of the four indexs alone. Conclusion:The BIG score can be an independent predictor of early outcome in children with moderate to severe TBI. The combination of BIG score，hemoglobin，lactic acid，and glucose has better performance for predicting the prognosis of moderate to severe TBI in children than any of the four indices alone.

Objective:To analyze the relationship between clinical symptoms，BIG score，laboratory examination and the prognosis of children with moderate to severe traumatic brain injury (TBI)，to determine the indicators associated with poor prognosis，in order to make early judgment for the prognosis of children with moderate to severe TBI.Methods:A total of 78 children with moderate to severe TBI were enrolled in the PICU of Jiangxi Provincial Children's Hospital from January 2022 to January 2023. Clinical data，laboratory tests，BIG scores and Glasgow prognostic score were collected upon admission. The patients were followed up for 6 months and divided into poor prognosis group（Glasgow prognostic score1-3）and good prognosis group（Glasgow prognostic score4-5）based on the Glasgow prognostic score. The indicators related to poor prognosis were selected，and the efficacy of the indicators to predict the prognosis was analyzed and compared.Results:There were statistical differences among BIG score，hemoglobin，lactic acid，glucose，respiratory failure，and hypotension shock（ P<0.05）. The BIG score was an independent risk factor for a poor prognosis. The BIG score had the highest AUC value（0.820）among the four indices. The combined indices（BIG score，hemoglobin，lactic acid，glucose）had the highest AUC value（0.851）and had better performance for predicting the prognosis of moderate to severe TBI in children than any of the four indexs alone. Conclusion:The BIG score can be an independent predictor of early outcome in children with moderate to severe TBI. The combination of BIG score，hemoglobin，lactic acid，and glucose has better performance for predicting the prognosis of moderate to severe TBI in children than any of the four indices alone.

Objective:To establish a BGJ398-resistant orthotopic model of intrahepatic cholangiocarcinoma(ICC)in mice that simulates the fibroblast growth factor receptor 2(FGFR2)gene rearrangement/fusion mutations and FGFR2 kinase domain mutations in clinical patients,in order to provide a tool for relavant research.Methods:Modified FGFR2 gene encoding FGFR2 protein that's prone to phosphorylation activation was introduced into the mouse liver using hydrodynamic tail vein injection technology to establish a BGJ398-sensitive orthotopic model of ICC.Plasmids injected include pT3-myr-AKT-HA,pT3-EF1a-NICD1,pCMV(CAT)T7-SB100 and pSB[Exp]-myr-FGFR2-FLAG.Then,the mice were treated with BGJ398 for 4 weeks to induce resistance to BGJ398.Ultrasound imaging was used to monitor bile duct obstruction lesions in the model mice in order to access the extent of resistance to BGJ398.HE staining and oil red O staining were used to analyze liver tissue sections for the histological features of the BGJ398-resistant orthotopic ICC model.Immunofluorescence staining was used to analyze the origin of the ICC cells from BGJ398-resistant mice.Primary tumor cells were extracted from the model mice and CCK-8 assay was performed to analyze their sensitivity to BGJ398 in vitro as well as the median inhibition concentration(IC50)of BGJ398.The model mice were treated with BGJ398 and the survival curves were plotted to verify the resistance of the ICC mouse model to drug treatment in vivo.DNA was extracted from drug-resistant ICC tissues and genomic resequencing was used to verify mutations in the kinase domain of the FGFR2 sequence.Results:The successful rate of the BGJ398-resistant orthotopic ICC mouse model construction was 93.33%,with significant tumor burden observed in the liver.Histologically,ICC tumor tissue was arranged in glandular duct patterns in the liver.Large numbers of lipid droplet vacuoles appeared in HE staining and oil red O staining.Immunofluorescence staining of the liver tissue showed positive results for biliary epithelial cell marker cytokeratin 19(CK19)and negative results for hepatocyte marker albumin(ALB).Primary ICC tumor cells were extracted and cultured,and CCK-8 results showed that the IC50 value for BGJ398 was 95.22 nmol in BGJ398-sensitive cells while the number increased to 348.4 nmol in BGJ398-resistant cells.After treatment with BGJ398 through intraperitoneal injection,the survival rate for BGJ398-resistnat mice was significantly lower than that of BGJ398-sensitive mice(P=0.001 7).Subsequent genomic resequencing revealed significant mutations in the FGFR2 gene,verifying that the mutations in the orthotopic ICC mouse model was consistent with those found in clinical ICC patients.Conclusion:This study has successfully established a BGJ398-resistant orthotopic ICC mouse model,providing valuable tools for further exploration of the molecular mechanisms of resistance to FGFR inhibitors and the development of new treatment methods.

Objective:To establish a BGJ398-resistant orthotopic model of intrahepatic cholangiocarcinoma(ICC)in mice that simulates the fibroblast growth factor receptor 2(FGFR2)gene rearrangement/fusion mutations and FGFR2 kinase domain mutations in clinical patients,in order to provide a tool for relavant research.Methods:Modified FGFR2 gene encoding FGFR2 protein that's prone to phosphorylation activation was introduced into the mouse liver using hydrodynamic tail vein injection technology to establish a BGJ398-sensitive orthotopic model of ICC.Plasmids injected include pT3-myr-AKT-HA,pT3-EF1a-NICD1,pCMV(CAT)T7-SB100 and pSB[Exp]-myr-FGFR2-FLAG.Then,the mice were treated with BGJ398 for 4 weeks to induce resistance to BGJ398.Ultrasound imaging was used to monitor bile duct obstruction lesions in the model mice in order to access the extent of resistance to BGJ398.HE staining and oil red O staining were used to analyze liver tissue sections for the histological features of the BGJ398-resistant orthotopic ICC model.Immunofluorescence staining was used to analyze the origin of the ICC cells from BGJ398-resistant mice.Primary tumor cells were extracted from the model mice and CCK-8 assay was performed to analyze their sensitivity to BGJ398 in vitro as well as the median inhibition concentration(IC50)of BGJ398.The model mice were treated with BGJ398 and the survival curves were plotted to verify the resistance of the ICC mouse model to drug treatment in vivo.DNA was extracted from drug-resistant ICC tissues and genomic resequencing was used to verify mutations in the kinase domain of the FGFR2 sequence.Results:The successful rate of the BGJ398-resistant orthotopic ICC mouse model construction was 93.33%,with significant tumor burden observed in the liver.Histologically,ICC tumor tissue was arranged in glandular duct patterns in the liver.Large numbers of lipid droplet vacuoles appeared in HE staining and oil red O staining.Immunofluorescence staining of the liver tissue showed positive results for biliary epithelial cell marker cytokeratin 19(CK19)and negative results for hepatocyte marker albumin(ALB).Primary ICC tumor cells were extracted and cultured,and CCK-8 results showed that the IC50 value for BGJ398 was 95.22 nmol in BGJ398-sensitive cells while the number increased to 348.4 nmol in BGJ398-resistant cells.After treatment with BGJ398 through intraperitoneal injection,the survival rate for BGJ398-resistnat mice was significantly lower than that of BGJ398-sensitive mice(P=0.001 7).Subsequent genomic resequencing revealed significant mutations in the FGFR2 gene,verifying that the mutations in the orthotopic ICC mouse model was consistent with those found in clinical ICC patients.Conclusion:This study has successfully established a BGJ398-resistant orthotopic ICC mouse model,providing valuable tools for further exploration of the molecular mechanisms of resistance to FGFR inhibitors and the development of new treatment methods.

Objective To investigate the treatment,outcomes and disease burden of severe hand-foot-and mouth diseases(HFMD),and to evaluate the compliance to the 2011 guideline for treatment in regions with a high in-cidence of HFMD.Methods A collaborative study group was established including Children's Hospital of Fudan Uni-versity,Jiangxi Provincial Children's Hospital,Anhui Provincial Children's Hospital,Linyi People's Hospital and the Second People's Hospital of Fuyang City.Clinical manifestation,treatment,prognosis and other data of severe HFMD pa-tients were prospectively collected by filling out a survey form in real time from April 2014 to October 2016. Results Two hundred and twenty-six severe HFMD cases were collected during the research time,including 114 ca-ses in stage 2,75 cases in stage 3,and 37 cases in stage 4.Two hundred and twenty-one cases(97.8%)were given mannitol,with a mortality of 6.2%;91 cases(40.3%)were given mannitol and glycerol fructose,with a mortality of 3.3%;the combined use of mannitol and glycerol fructose might have a better result than the single use of mannitol. One hundred and ninety-eight cases(87.6%)were given intravenous immunoglobulin(IVIG).One hundred and ninety cases(84.1%)were given antiviral drugs.One hundred and forty-five cases(64.2%)were given hormone therapy,and the use of hormone could reduce temperature,but did not reduce the mortality.One hundred and fifty cases (66.4%)needed vasoactive agent,including milrinone,dobutamine,phentolamine and sodium nitroprusside. The vasoactive agent use in stage 3 and 4 were 88.0%(66/75 cases)and 91.9%(34/37 cases),respectively.Sixty-nine cases(30.5%)received continuous positive airway pressure(CPAP),91 cases(40.3%)with mechanical ventila-tion,peak inspiratory pressure(PIP)≥20 cmH2O(1 cmH2O=0.098 kPa)accounted for 61.6%(53/86 cases),po-sitive end-expiratory pressure(PEEP)≥10 cmH2O accounted for 36.3%(33/91 cases).The mean mechanical ven-tilation time was(125.9 ± 101.8)h.Eleven cases(4.86%)died or died after giving up treatment,in which the mortality in stage 3 was 6.7%(5/75 cases),and the mortality in stage 4 was 16.2%(6/37 cases).The death causes were respiratory failure,pulmonary hemorrhage,and circulatory failure. The average time from onset to death was (5.91 ± 5.26)(1-15)d.Length of stay in hospital was(9.18 ± 5.16)(1-37)d in which length of stay in hospi-tal in stage 3 and 4 were(11.3 ± 6.35)d,(11.4 ± 6.62)d,respectively,which were significantly longer than that in stage 2[(7.50 ± 3.04)d],and the difference was statistically significant(P <0.05). The cost was(19 136 ± 12 556)CNY,of which the cost in stage 3 and 4 was(23 121 ± 13 846)CNY,(29 849 ± 16 015)CNY,respectively, which were significantly higher than that in stage 2[(12 961 ± 4 272)CNY],and the difference was statistically sig-nificant(P<0.05). Multivariate analysis found that respiratory rhythm abnormality,capillary refill time more than 3 seconds were risk factors for the deaths in the severe HFMD.Conclusion The 2011 edition of guidelines for treat-ment of children with severe HFMD was well executed.Hormone,IVIG,antiviral drugs did not significantly reduce the mortality of severe HFMD in children.

Objective To investigate the clinical features of severe hand,foot and mouth disease (HFMD) in recent three years,and to analyse the risk factors of severe HFMD.Methods A multicenter collaborative research group was set up,including five children's hospitals(pediatric department)with high incidence of HFMD.Prospective epidemiologic approaches were adopted.After training,staffs from the col-laborative center executed the study by filling up the record forms.Results We collected 114 HFMD cases in stage 2,75 cases of HFMD in stage 3,37 cases of HFMD in stage 4 from April 2014 to October 2016.The age ranged from 2 months to 13 years old,the median age was 2 years old,younger than 3 years accounted for 86.3%.Fever was observed in all the severe HFMD,mean temperature was (39.2 ± 0.7) ℃,fever lasted for (4.54 ± 2.89)d.The mean heart rates in stage 2,3,4 were (128.2 ± 13.3,176.1 ± 22.2,184.2 ± 27.5) times/min,respectively.The mean arterial pressure was (84.4 ± 14.6) mmHg(1 mmHg=0.133 kPa),the mean respiratory rate was (39.0 ± 8.4)times/min,the mean respiratory rates in stage 2,3,4 were (37.8 ± 7.36,38.7 ± 8.13,43.4 ± 10.7) times/min,respectively. Respiratory rhythm abnormality in stage 2,3,4 were 9.6%,14.9% and 56.8%,respectively.The blood glucose increased gradually in 2,3 and 4 stages,the mean blood glucose in stage 4 was(12.4 ± 4.74)mmol/L.The incidence of coma in stage 4 was higher than those in stage 2 and 3. Multivariate Logistic regression analysis found that tachycardia,drowsiness,coma, respiratory rate increase,respiratory rhythm abnormality,capillary refilling time more than 3 seconds were risk factors for severe HFMD.Conclusion The incidence of severe HFMD is still high in children under 3 years of age in last three years.The severe patients have obvious changes in the nervous,respiratory and circulatory system. Tachycardia,drowsiness,coma,respiratory rate increase,respiratoy rhythm abnormality,capillary refilling time more than 3 seconds are risk factors for severe HFMD.

Objective To study the levels of plasma catecholamine( norepinephrine,epinephrine and dopamine) in children with severe hand,foot and mouth disease( HFMD) ,and to assess the influence of cate-cholamine on the pathogenesis of severe HFMD. Methods A collaborative study group was established, including Children′s Hospital of Fudan University, Jiangxi Provincial Children′s Hospital, Anhui Provincial Children′s Hospital,Linyi People′s Hospital and No. 2 People′s Hospital of Fuyang City. Blood samples from children with severe HFMD were collected from April 2014 to October 2016. The levels of blood epineph-rine,norepinephrine,dopamine were measured at 2 h,24 h and 48 h after diagnosis for HFMD. Results The level of epinephrine at 24 h after diagnosis was ( 213. 0 ± 139. 8 ) ng/L in children with pulmonary edema, which was significantly higher than that of children without pulmonary edema[(137. 8 ± 45. 5)ng/L)](P=0. 022). The level of epinephrine at 24 h after diagnosis was (373. 2 ± 298. 1)ng/L in the dead children,and was (144. 2 ± 42. 5)ng/L in the survival children. The concentration of norepinephrine at 24 h after diagnosis was (1935. 7 ± 1824. 1)ng/L in the dead children,and was (858. 3 ± 212. 7)ng/L in the survival children. The levels of epinephrine and norepinephrine of those who died from HFMD were significantly higher than those of survival children at 24 h after diagnosis. There were no significant differences in catecholamine con-centrations among stage 2,3,4 HFMDs at 2 h,24 h and 48 h after diagnosis. Sex and enterovirus 71 virus infection had no significant influences on plasma catecholamine concentrations in children with severe HFMD. Conclusion Plasma epinephrine levels increase in children with HFMD complicated with pulmonary edema. Epinephrine and norepinephrine may play an important role in the death of children with severe HFMD.

Objective To explore the changes and clinical significance of joint fluid TNF-α and TNF-β1 levels in patients with knee osteoarthritis (KOA). Methods A total of 90 patients with KOA hospitalized in our hospital were selected. They were assigned to group A with 30 patients at early stage, group B with 30 patients at medium stage,and group C with 30 patients at advanced stage according to the stage of X ray; 30 healthy volunteers were in the con-trol group. Levels of joint fluid TNF-αand TNF-β1 were tested in four groups of patients. Results Levels of joint fluid TNF-β1 at medium and advanced stages of KOA were significantly lower than those in the control group, and the dif-ferences were significant (P<0.01); Levels of joint fluid TNF-α at medium and advanced stages of KOA were signifi-cantly higher than those in the control group, and the differences were significant(P<0.01); the difference of levels of joint fluid TNF-α and TNF-β1 at early stage of KOA was not significant compared with those in the control group(P>0.05);levels of TNF-α/TNF-β1 at early,medium and advanced stage of KOA were significantly higher than those in the control group(P<0.01);TNF-αwas positively correlated with KOA stage(r=0.930,P<0.01);TNF-β1 was nega-tively correlated with KOA stage(r=-0.849,P<0.01);TNF-α/TNF-β1 was positively correlated with KOA stage(r=0.828,P<0.01). Conclusion TNF-α and TNF-β1 are involved in the formation and progression of OA, and levels of joint fluid TNF-α and TNF-β1 are able to reflect the severity of KOA lesions; joint fluid TNF-α/TNF-β1 is able to detect KOA early.

Objective To study the correlation between genetic polymorphisms of interleukin (IL)-1A/1B and susceptibility to tuberculosis (TB).Methods Genetic polymorphisms of IL-1A and IL1 B in 1032 TB patients and 1008 non-TB patients were analyzed using PCR-MassARRAY method.The correlation between genetic polymorphisms of IL-1A/1B and susceptibility to TB was statistically analyzed.Results Two tag SNPs of IL-1A and three tag SNPs of IL-1B were screened for the study.There were differences in the allele frequencies of rs2853550 and rs3783526 between TB group and non-TB group (P=0.047and P =0.034,respectively).IL-1 B SNP1 rs2853550 (P =0.025,OR =1.302,95 ％ CI =1.034-1.640,TC vs.CC) was found to be highly associated with TB,while the other SNPs showed no significant correlations with TB.Furthermore,IL-1B SNP1 rs2853550 [P=0.019,OR=1.308,95％ CI=1.045-1.638 for (TC+TT) vs.CC] in the dominant model conferred significant risk for TB,but IL-1A SNP2 rs3783526 [P=0.000,OR=0.764,95％ CI =0.591-0.988 for GG vs.(AA+GA)] in the recessive model showed protective effects against TB.The haplotype ‘TG’ in the IL-1B block showed a higher risk for TB compared with the common ‘ CA’ haplotype (P=0.032,OR=1.265,95％ CI=1.020-1.567).The diplotypes containing ‘ GA’ haplotype in IL-1A block and ‘ TG’ haplotype in IL-1B block were major risk factors for TB (for onecopy,adjusted P=0.014,OR=1.403 and 95％ CI=1.072-1.836; adjusted P=0.013,OR=1.339 and 95％ CI=1.063-1.688,respectively),but the diplotype with ‘CG’ in IL-1B block played a protective effect against TB (for two-copy,P=0.006,OR=0.664 and95％ CI=0.494-0.891).Conclusion The genetic polymorphisms of IL-1B rs2853550 might be closely associated with TB,but the GG genotype of IL1 A SNP rs3783526 might have the characteristic of anti-TB.