Objective:To investigate and summarize pediatric patients with severe Mycoplasma pneumoniae pneumonia (MPP) presenting with varied clinical and chest imaging features in order to guide the individualized treatment. Methods:This was a retrospective cohort study. Medical records of clinical, imaging and laboratory data of 505 patients with MPP who were admitted to the Department Ⅱ of Respirology Center, Beijing Children′s Hospital, Capital Medical University from January 2016 to October 2023 and met the enrollment criteria were included. They were divided into severe group and non-severe group according to whether lower airway obliterans was developed. The clinical and chest imaging features of the two groups were analyzed. Those severe cases with single lobe ≥2/3 consolidation (lobar consolidation) were further divided into subtype lung-necrosis and subtype non-lung-necrosis based on whether lung necrosis was developed. Comparison on the clinical manifestations, bronchoscopic findings, whole blood C-reactive protein (CRP) and other inflammatory indicators between the two subtypes was performed. Comparisons between two groups were achieved using independent-sample t-test, nonparametric test or chi-square test. Univariate receiver operating characteristic (ROC) curve analyses were performed on the indicators such as CRP of the two subtypes. Results:Of the 505 cases, 254 were male and 251 were female. The age of the onset was (8.2±2.9) years. There were 233 severe cases, among whom 206 were with lobar consolidation and 27 with diffuse bronchiolitis. The other 272 belonged to non-severe cases, with patchy, cloudy infiltrations or single lobe <2/3 uneven consolidation or localized bronchiolitis. Of the 206 cases (88.4%) severe cases with lobar consolidation, 88 harbored subtype lung-necrosis and 118 harbored subtype non-lung-necrosis. All 206 cases (100.0%) presented with persistent high fever, among whom 203 cases (98.5%) presented with inflammatory secretion obstruction and plastic bronchitis under bronchoscopy. Of those 88 cases with subtype lung-necrosis, there were 42 cases (47.7%) with dyspnea and 39 cases (44.3%) with moderate to massive amount of pleural effusion. There were 35 cases (39.8%) diagnosed with lung embolism during the disease course, of which other 34 cases (38.6%) were highly suspected. Extensive airway mucosal necrosis was observed in 46 cases (52.3%), and the level of their whole blood CRP was significantly higher than that of subtype non-lung-necrosis (131.5 (91.0, 180.0) vs. 25.5 (12.0, 43.1) mg/L, U=334.00, P<0.001). They were regarded as subtype "lung consolidation-atelectasis-necrosis". Of those 118 cases with subtype non-lung-necrosis, 27 cases (22.9%) presented with dyspnea and none were with moderate to massive amount of pleural effusion. Sixty-five cases (55.1%) presented with plastic bronchitis and localized airway mucosal necrosis was observed in 32 cases (27.1%). They were deemed as subtype "lung consolidation-atelectasis". ROC curve analyses revealed that whole blood CRP of 67.5 mg/L on the 6-10 th day of disease course exhibited a sensitivity of 0.96, a specificity of 0.89, and an area under the curve of 0.97 for distinguishing between these two subtypes among those with lobar consolidation. Conclusions:Pediatric patients with severe MPP present with lobar consolidation or diffuse bronchiolitis on chest imaging. Those with lobar consolidation harbor 2 subtypes as "lung consolidation-atelectasis-necrosis" and "lung consolidation-atelectasis". Whole blood CRP of 67.5 mg/L can be applied as an early discriminating indicator to discriminate between these two subtypes.

Objective:To investigate the clinical efficacy of cyclophosphamide combined with leflunomide in the treatment of lupus nephritis.Methods:The clinical data of 90 patients with lupus nephritis who received treatment in The Second People's Hospital of Liaocheng from January 2019 to June 2020 were retrospectively analyzed. These patients were divided into two groups according to different treatment methods. The single drug group ( n = 45) was treated with cyclophosphamide alone, and the combined drug group ( n = 45) was treated with cyclophosphamide combined with leflunomide. All patients were treated for 6 months. Total response rate, inflammatory factor level, immune function, renal function, and adverse reactions were compared between the two groups. Results:Total response rate in the combined drug group was 95.56% (43/45), which was significantly higher than 82.22% (37/45) in the single drug group ( χ2 = 4.05, P < 0.05). After treatment, interleukin-6, C-reactive protein, and rheumatoid factor in the combined drug group were (45.21 ± 5.07) ng/L, (3.13 ± 1.01) mg/L, (43.37 ± 18.20) IU/mL, respectively, which were significantly lower than (60.20 ± 6.13) ng/L, (6.23 ± 1.31) mg/L, (73.19 ± 19.17) IU/mL in the single drug group ( t = 12.64, 12.57, 7.56, all P < 0.001). Immunoglobulin A and immunoglobulin G levels in the combined drug group were significantly lower than those in the single drug group ( t = 13.05, 13.40, both P < 0.001), but immunoglobulin M level in the combined drug group was significantly higher than that in the single drug group ( t = 13.51, P < 0.001). Serum creatinine and 24-hour urine protein levels in the combined drug group were (78.23 ± 19.13) μmol/L and (1.15 ± 0.33) g/24 hours, respectively, which were significantly lower than (92.19 ± 20.19) μmol/L and (3.15 ± 0.81) g/24 hours in the single drug group ( t = 3.36, 15.33, both P < 0.001). The incidence of adverse reactions in the combined drug group was 6.67% (3/45), which was significantly lower than 22.22% (10/45) in the single drug group ( χ2 = 4.40, P < 0.05). Conclusion:Cyclophosphamide combined with leflunomide is effective against lupus nephritis. The combined therapy can regulate the inflammatory reaction, improve the immune function, promote the recovery of renal function, and be safe.

Objective:To analyze the status quo and influencing factors of accidental prolapse of peripherally inserted central catheter (PICC) in children, so as to provide references for formulating preventive measures.Methods:Using the convenient sampling method, a total of 1 268 pediatric patients who underwent catheterization at Intravenous Catheter Nursing Studio of Beijing Children's Hospital, Capital Medical University from January to December 2021 were selected as the research objects to analyze the incidence of PICC accidental prolapse. Logistic regression was used to analyze the influencing factors of PICC accidental prolapse.Results:Of the 1 268 children included in this study, 29 were excluded from follow-up and 1 239 children were eventually included. A total of 1 339 PICCs were implanted in 1 239 children, and the incidence of PICC accidental prolapse was 5.60% (75/1 339). Logistic regression analysis showed that whether the children had skin rash, time, location and catheter indentation time were the influencing factors for the occurrence of PICC accidental prolapse ( P<0.05) . Conclusions:The incidence of children's PICC accidental prolapse is at a high level, which is affected by many factors. Nursing staff should formulate effective preventive measures according to the influencing factors of PICC accidental prolapse, reduce the occurrence of children's accidental catheterization and extend the retention time of PICC.

Objective:To investigate the effect of hemodiafiltration combined with Jinshuibao tablet on serum inflammatory factors and oxidative stress indices in patients with diabetic nephropathy. Methods:A total of 86 patients with diabetic nephropathy who received treatment in The Second People's Hospital of Liaocheng from April 2019 to April 2020 were included in this study. They were randomly assigned to receive either hemodiafiltration (control group, n = 42) or hemodiafiltration combined with Jinshuibao tablet (observation group, n = 44). Microinflammatory state, oxidative stress index level, renal function and nutritional status were compared between the two groups. Results:Before treatment, serum interleukin-6, high-sensitivity C-reactive protein and tumor necrosis factor-α levels in the control group were (30.13 ± 3.25) ng/L, (9.43 ± 2.57) mg/L, (46.69 ± 3.54) ng/L respectively, and they were (30.16 ± 3.34) ng/L, (9.48 ± 2.65) mg/L, (46.73 ± 3.38) ng/L respectively in the observation group. There were no significant differences in these indices between the two groups (all P > 0.05). After treatment, serum interleukin-6, high-sensitivity C-reactive protein and tumor necrosis factor-α levels in the control group were (16.69 ± 2.73) ng/L, (8.12 ± 2.21) mg/L, (35.63 ± 2.75) ng/L, respectively, and they were (12.34 ± 2.52) ng/L, (6.47 ± 1.53) mg/L, (26.65 ± 2.13) ng/L, respectively in the observation group. After treatment, serum interleukin-6, high-sensitivity C-reactive protein and tumor necrosis factor-α levels in both groups were significantly lower than those before treatment (control group: t = 20.52, 2.50, 15.99; observation group: t = 27.60, 6.16, 32.57, all P < 0.05). After treatment, serum interleukin-6, high-sensitivity C-reactive protein and tumor necrosis factor-α levels were significantly lower than those in the control group ( t = 7.68, 4.04, 16.97, all P < 0.05). Before treatment, serum levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase in the control group were (5.63 ± 1.36) nmol/L, (63.38 ± 7.56) mU/L, and (195.96 ± 26.36) IU/L, respectively, while those in the observation group were (5.68 ± 1.25) nmol/L, (63.25 ± 7.38) mU/L, and (195.83 ± 26.27) IU/L, respectively. There were no significant differences in these indices between the two groups (all P > 0.05). After treatment, serum levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase in the control group were (4.83 ± 1.13) nmol/L, (83.46 ± 5.75) mU/L and (236.69 ± 18.75) IU/L respectively, while those in the observation group were (4.24 ± 0.86) nmol/L, (88.75 ± 5.47) mU/L and (258.76 ± 15.47) IU/L, respectively. After treatment, serum levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase in each group were superior to those before treatment (control group: t = 2.93, 13.70, 8.16, P = 0.002, < 0.001, < 0.001; observation group: t = 6.15, 17.99, 13.37, all P < 0.001). After treatment, serum levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase in the observation group were superior to those in the control group ( t = 2.73, 4.37, 5.96, P = 0.004, < 0.001, < 0.001). After treatment, blood urea nitrogen, serum creatinine and 24-hour urine protein in the observation group were significantly lower than those in the control group ( t = 7.85, 8.71, 2.06, P < 0.001, < 0.001, 0.021), and creatinine clearance rate in the observation group was significantly higher than that in the control group ( t = 3.01, P = 0.002). Total protein, prealbumin and albumin levels in the observation group were significantly higher than those in the control group ( t = 9.47, 12.13, 6.18, all P < 0.001). Conclusion:Hemodiafiltration combined with Jinshuibao tablet for the treatment of diabetic nephropathy has a positive effect on microinflammatory state and oxidative stress index level and improves patient's renal function and nutritional status.

Objective:To investigate the efficacy of tripterygium glycoside tablets combined with irbesartan for chronic nephritis and its effect on 24-hour urine protein and inflammatory factor levels.Methods:Ninety patients with chronic nephritis who received treatment at The Second People's Hospital of Liaocheng from April 2018 to January 2020 were included in this study. They were randomly divided into an observation group and a control group, with 45 patients in each group. The control group was treated with irbesartan. The observation group was treated with tripterygium glycoside tablets combined with irbesartan. All patients were treated for 3 successive months. Clinical efficacy and adverse reactions were compared between the two groups. Changes in 24-hour urine protein level, symptom score, and inflammatory factor levels after treatment relative to those before treatment were compared between the two groups.Results:Response rate in the observation group was significantly higher than that in the control group [95.6% (43/45) vs. 80.0% (36/45), χ2 = 5.07, P = 0.024). Before treatment, there were no significant differences in 24-hour urine protein level, symptom score, and inflammatory factor level between the two groups (all P > 0.05). After treatment, the 24-hour urine protein level in the observation group was significantly lower than that in the control group [(1.42±0.01) g/24 hours vs. (1.95 ± 0.05) g/24 hours, t = 69.72, P = 0.012). The symptom score in the observation group was significantly lower than that in the control group [(0.78 ± 0.01) points vs. (1.33 ± 0.12) points, t = 30.64, P = 0.001]. Serum levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α in the observation group were significantly lower than those in the control group ( t = 15.70, P = 0.006; t = 96.55, P = 0.003; t = 43.41, P = 0.002). There was no significant difference in the incidence of adverse reactions between the two groups ( P = 0.694). Conclusion:Tripterygium glycoside tablets combined with irbesartan is highly effective on chronic nephritis. The combined therapy can remarkably decrease 24-hour urine protein levels, reduce symptom scores, and decrease inflammatory factor levels.

Objective:To explore the pain perception and cognition of children with malignant tumor and their parents during the disease treatment.Methods:Using the convenient sampling method, a total of 179 children with malignant tumors and their 179 parents who were admitted to the day ward of Hematology and Oncology Center of Beijing Children's Hospital, Capital Medical University from June 2017 to February 2019 were selected as the research objects. The children and their parents were surveyed by using the self-developed Pain Questionnaire for Children with Malignant Tumor and the Pain Questionnaire for Parents of Children with Malignant Tumor. A total of 179 questionnaires were distributed, 179 valid questionnaires were recovered, and the effective recovery rate was 100.0%.Results:The incidence of pain during treatment in 179 parents and 179 children was 100.0% (179/179) and 98.3% (176/179) , respectively. The average scores of 179 parents and 179 children who considered the most severe pain during disease treatment were respectively (5.82±2.30) and (5.41±2.09) , and the average pain scores were (4.04±1.90) and (3.95±1.66) , respectively. There were statistically significant differences in pain perception between children and their parents during lumbar puncture/thecal injection, bone puncture, PICC catheter placement, indwelling needle puncture and venous blood collection ( P<0.05) . A total of 77.1% (138/179) of parents and 65.4% (117/179) of children had concerns about the use of analgesics, respectively. Conclusions:There is a high consistency between the severity of pain experienced by parents and the children's feelings during treatment. However, the parents feel that the unbearable treatment-related pain during the treatment of the disease is higher than that of children, and they are more passive than children in the attitude of receiving analgesics. Medical staff can listen to their parents' opinions during pain assessment, pay attention to education of parents before treatment-related operations, take measures to reduce or even avoid the occurrence of treatment-related pain and strengthen the training of pain relief measures.

Objective:To analyze the influence of clinicopathological features on the prognosis of anorectal malignant melanoma (AMM), and to establish a more accurate prognosis prediction model.Methods:From January 1, 2006 to December 31, 2018, at Fudan University Shanghai Cancer Center, the data of 89 patients diagnosed with AMM and underwent operation were retrospectively analyzed. The Cox proportional hazard regression model was used to analyze factors affecting the prognosis. Backward elimination was used to select variables, Nomogram prognosis prediction model was established and verified internally, and the consistency index was calculated.Results:Among 89 AMM patients, 65 (73.0%) were female, 78(87.6%) were <70 years old, and the most common tumor location was the rectum (48.3%, n=43), followed by the anal canal (31.5%, n=28) and the anorectal canal (20.2%, n=18). Thirty-eight (42.7%) patients directly received abdominal-perineal resection (APR), 37 patients (41.6%) received interferon-based immunotherapy, and 11 patients (12.4%) received both systemic chemotherapy and immunotherapy. The 3-year disease-specific survival (DSS) rate was 41.6%(37/89), and the 5-year DSS rate was 31.5%(28/89). The results of multivariate Cox analysis showed that age ≥70 years old and T2 stage were risk factors of the prognosis of AMM patients (hazard ratio ( HR)=11.29, 4.83; 95% confidence interval ( CI) 2.89 to 44.13, 1.66 to 14.11; both P<0.01), while neurovascular invasion, immunotherapy treatment, systemic chemotherapy combined with immunotherapy, APR after extensive local resection, directly APR and APR combined with inguinal lymphadenectomy were protective factors of the prognosis ( HR=0.09, 0.23, 0.10, 0.13, 0.26, 0.02; 95% CI 0.02 to 0.34, 0.10 to 0.57, 0.02 to 0.49, 0.03 to 0.52, 0.08 to 0.90, 0.00 to 0.27; all P<0.05). The Nomogram model was further established with age, gender, tumor location, T stage, distant metastasis, medication chemotherapy and surgical treatment. The results of the Nomogram model internal verification indicated that the accuracy of the model in predicting 1-year, 3-year and 5-year DSS was good, and the consistency index was 0.749, which was significantly higher than the consistency index of traditional TNM stage (0.607). Conclusions:Most AMM patients are <70 years old, and the majority of them are female. The common location of AMM is rectum, and many patients receive immunotherapy. Age ≥70 years old and T2 stage are risk factors affecting the prognosis of AMM patients. Neurovascalar invasion, immunotherapy based comprehensive treatment, APR after extensive local resection, directly APR and APR combined with inguinal lymphadenectomy are protective factors of the prognosis. Nomogram prognosis prediction model established based on the clinicopathological features and treatment of AMM patients has higher accuracy and clinical reference value than the traditional TNM stage system.

Objective To explore the occurrence of pain in the treatment of children with malignant tumors and their perception and cognition of pain, and provide a reference for strengthening pain management and formulating clinical nursing measures. Methods Totally 179 children with malignant tumors admitted in the daytime wards of a Class Ⅲ Grade A children's hospital in Beijing from June 2017 to October 2018 were selected and investigated with the self-made pain questionnaire for children with malignant tumors. Totally 179 questionnaires were distributed and collected in this study, accounting for an effective recovery rate of 100％. Results The incidence of pain in the 179 children was 98.3％ (176/179). The severest pain score was (5.41±2.09), and the average pain score was (3.95±1.66). Pain involved the abdomen, lower limbs, oral mucosa, bones and joints, waist, back, upper limbs, chest, perianal mucosa, neck, head and face, perineum, ear, nose, throat and eyes. Totally 83.8％(150/179) of the children informed the medical staff in time when the pain occurred, hoping to get analgesic treatment; 35.2％ of the children were willing to receive analgesics. In the 179 Children, the children believed that 84.6％ of the pain was related to the treatment procedure; 46.6％ (82/179) was related to the disease itself; and the most unbearable treatment procedure was lumbar puncture/ intrathecal injection. Conclusions Children with malignant tumors have a higher incidence and severity of pain during the treatment of the disease, and the pain is widespread. Most children hope to receive analgesic treatment, but they do not have enough knowledge about analgesics. Medical staff should pay attention to the pain of children with malignant tumors, strengthen pain management, and take measures to reduce and even avoid treatment-related pain.

Algorithms ; Crystallography, X-Ray ; Disulfides ; chemistry ; Models, Molecular ; Protein Conformation ; Proteins ; chemistry

Objective To study the diagnostic value of combined detection of serum CEA,CA199,CA125,AFP and fecal occult blood(FOB) in Dukes B stage colon carcinoma.Methods The above indicators in 56 patients with colon carcinoma (colon carcinoma group),35 patients with colonic polyp benign disease and 41 healthy individuals undergoing physical examination were measured.Then the sensitivity,and specificity of single index detection and their combined detection were analyzed.Results The levels and positive rates of CEA,CA199,CA125 and FOB in the colon cancer group were significantly higher than those in the colonic polyp group and healthy control group (P＜0.05),but the AFP level and positive rate had no statistical difference compared with the colonic polyp group.Serum CEA,CA125,CA199 and FOB were selected into the Logistic regression equation.The corresponding areas under the curve (AUC) were 0.745,0.886,0.792 and 0.864 respectively;the positive detection rates were 48.2 ％,35.7 ％,39.3 ％ and 78.6 ％ respectively.The combined detection could increased the specificity,sensitivity and AUC to 87.5 ％,92.1％ and 0.957,which were more superior to that in the single index detection.Conclusion The combined detection of serum CEA,CA199,CA 125 and FOB can provide the powerful basis for early diagnosing colonic cancer.