Objective:To describe the epidemiological characteristics of respiratory syncytial virus (RSV) infection in preschool children and explore the risk factors for severe pneumonia.Methods:Epidemiological data of 279 preschool children with RSV infection were investigated. The children were screened for severe pneumonia and separated into ordinary and severe types. General data and laboratory test data from both groups were compared, and binary logistic regression model analysis was applied to determine the risk factors for severe pneumonia.Results:Preschool children with RSV infection were mostly male (63.08%), <6 months old (65.95%) and had poor living environment (53.05%), with main symptoms of cough (91.04%) and wheezing (69.18%), the lung auscultation was mainly characterized by wheezing (86.74%), and imaging findings were mainly patchy shadows (76.34%), the onset season was concentrated in autumn (31.18%) and winter (43.37%). The detection rate of severe pneumonia in 279 pediatric patients was 20.27% (56/279). The proportions of onset season being autumn or winter, low birth weight infants, history of respiratory infections within 3 months, delayed treatment, neutrophils count <10×10 9/L, C-reactive protein≥10 mg/L, procalcitonin≥1.5 ng/mL, albumin<30 g/L, CD4 + /CD8 + <1.2 in the severe types were higher than those in the normal types ( P<0.05). Logistic regression analysis showed that the onset season was autumn or winter ( OR=2.316, 95% CI: 1.235-4.345), low birth weight infants ( OR=2.679, 95% CI: 1.442-4.977), history of respiratory infections within 3 months ( OR=2.815, 95% CI: 1.539-5.148), delayed treatment ( OR=2.869, 95% CI: 1.581-5.206), low albumin<30 g/L ( OR=2.756, 95% CI: 1.495-5.080), and low CD4 + /CD8 + <1.2 ( OR=3.016, 95% CI: 1.695-5.366) were risk factors for severe RSV pneumonia in preschool children ( P<0.05). Conclusions:Autumn and winter, low birth weight infants, history of respiratory infections within 3 months, delayed treatment, low albumin, and low CD4 + /CD8 + are related to the occurrence of severe RSV pneumonia in preschool children. Therefore, it is necessary to strengthen the attention to the condition of preschool RSV infected children with the above risk factors, and actively intervene in controllable factors to reduce the risk of severe pneumonia.

Objective To explore the value of 3D amide proton transfer weighted imaging(APTWI),diffusion weighted imaging(DWI)and the combination for differentiating benign and malignant bone and soft tissue tumors.Methods Non-contrast MRI,APTWI and DWI of pelvis or lower extremity were prospectively acquired in 96 patients with bone and soft tissue tumors.MTRasym and ADC maps were obtained based on APTWI and DWI calculation with an offset of 3.5 ppm,respectively,and the maximum asymmetric magnetization transfer rate(MTRasym)(MTRasymmax),the mean MTRasym(MTRasymmean)and the minimum MTRasym(MTRasymmin),as well as the maximum apparent diffusion coefficient(ADC)(ADCmax),the mean ADC(ADCmean)and the minimum ADC(ADCmin)values were measured.The above parameters were compared between benign and malignant tumors.Then receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of APTWI,DWI and the combination.Results Among 96 patients,there were 41 benign and 55 malignant pelvic or lower limb bone and soft tissue tumors.In benign tumors,MTRasym(3.5 ppm)values,including MTRasymmax.MTRasymmean and MTRasymmin were significantly higher,whereas ADC values including ADCmax,ADCmeanand ADCmin were significantly lower than those in malignant tumors(all P＜0.05).AUC of MTRasymmax and ADCmin for differentiating benign and malignant bone and soft tissue tumors was 0.791 and 0.873,respectively,being not statistically different(P=0.122),but both lower than that of their combination(AUC=0.944,P＜0.001,P=0.041).Conclusion APTWI combined with DWI had high efficacy for differentiating benign and malignant bone and soft tissue tumors.

Objective:To investigate the value of nomogram based on radiomics features of CT enterography (CTE) combined with clinical characteristics to predict secondary loss of response (SLOR) after infliximab (IFX) treatment in patients with Crohn′s disease (CD).Methods:This study was a case-control study. Clinical and imaging data of 155 patients with CD diagnosed at the First Affiliated Hospital of Anhui Medical University from March 2015 to July 2022 were retrospectively collected. The patients were divided into a training set ( n=108) and a testing set ( n=47) in the ratio of 7∶3 by stratified sampling method. All patients were treated according to the standardized protocol and were classified as SLOR (43 in the training set and 18 in the testing set) and non-SLOR (65 in the training set and 29 in the testing set) according to treatment outcome. Based on the data from the training group, independent clinical predictors of SLOR after IFX treatment were screened in the clinical data using univariate and multivariate logistic regression analysis to establish a clinical model. Intestinal phase images were selected to be outlined layer by layer along the margin of the lesion to obtain the volume of the region of interest to extract the radiomics features. The radiomics features were screened using univariate analysis and the minimum absolute shrinkage and selection operator to establish the radiomics model. Multivariate logistic regression analysis was used to build a combined clinical-radiomics model based on the screened clinical independent predictors and radiomics characters, then a nomogram was drawn. The predictive efficacy of the 3 models for SLOR after IFX treatment was assessed by receiver operating characteristic curves, and the area under the curve (AUC) was calculated. The decision curve analysis was applied to evaluate the clinical utility of the models. Results:Disease duration ( OR=1.983, 95% CI 1.966-2.000, P=0.046) and intestinal stenosis ( OR=1.246, 95% CI 1.079-1.764, P=0.015) were identified as the independent predictors of SLOR in the clinical data, and a clinical model was established. Totally 9 radiomics features were included in the radiomics model. The AUCs of clinical, radiomics, and combined models for predicting SLOR after IFX treatment in CD patients were 0.691 (95% CI 0.591-0.792), 0.896 (95% CI 0.836-0.955), and 0.910 (95% CI 0.855-0.965) in the training set, and 0.722 (95% CI 0.574-0.871), 0.866 (95% CI 0.764-0.968), and 0.889 (95% CI 0.796-0.982) in the testing set. Decision curve analysis in the testing set showed higher net clinical benefits for both the radiomics model and combined model than the clinical model, and combined model had higher net clinical benefits than the radiomics model over most threshold probability intervals. Conclusions:CTE-based radiomics model can effectively predict SLOR after IFX treatment in patients with CD, and a combined model by incorporating clinical characteristics of disease duration and intestinal stenosis can further improve the predictive efficacy.

Objective Stereotactic body radiotherapy(SBRT)and radiofrequency ablation(RFA)are primary treatments for hepatocellular carcinoma(HCC)at present.However,the effect of these treatments in clinical trails are rather controversial.The purpose of this paper is to conduct a meta-analysis on the clinical effect and related complications of SBRT and RFA for HCC.Methods A computerized retrieval of academic papers concerning the treatment effect of SBRT and RFA for HCC from the databases of PubMed,Embase,Cochrane Library,Scopus,Web of Science,CBM,CNKI,Wanfang database,VIP was conducted.The retrieval time period was from the establishment of the database to June 2022.Stata14.0 software was used to make meta-analysis.Results A total of 14 retrospective studies including 6 806 patients were included in this analysis.The results of combined hazard ratio(HR)based on overall survival(OS)showed that the OS rate of SBRT was lower than that of RFA(HR=1.25,95％CI=1.10-1.43,12=0％,P=0.000 9),while the results of combined HR of local control(LC)rate indicated that SBRT had a better therapeutic effect(HR=0.61,95％CI=0.47-0.78,I2=0％,P=0.000 1).Subgroup analysis revealed that the combined HR of LC rate favored the performance of SBRT for patients with tumor diameter larger than 2 cm(HR=2.64,95％CI=1.56-4.48,I=0％,P=0.000 3).No statistically significant difference in the incidence of late serious adverse reactions existed between SBRTgroup and RFA group(OR=1.01,95％CI=0.59-1.73,I2=30％,P=0.97).Conclusion SBRT is superior to RFA in controlling local HCC lesions,especially in patients whose tumor diameter is larger than 2 cm,although it does not show certain advantages in the survival benefit.(J Intervent Radiol,2023,32:1233-1241)

Purpose: This study aimed to investigate reproductive concerns among breast cancer patients of reproductive age, analyze the influencing factors, explore the relationship between coping styles, fear of progression (FOP), and reproductive concerns, and identify the multiple effects of coping styles on the relationship between FOP and reproductive concerns among Chinese breast cancer patients. Methods: A cross-sectional, descriptive study was conducted among breast cancer patients in four tertiary grade A hospitals in Fujian, China, from January 2022 to September 2022. A total of 210 patients were recruited to complete paper-based questionnaires, which included the general data questionnaires, the Reproductive Concerns After Cancer Scale (RCACS), the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), and the Medical Coping Modes Questionnaire (MCMQ). Structural equation models were utilized to evaluate the multiple effects of coping styles on FOP and reproductive concerns. Results: Reproductive concerns in breast cancer patients had a mean score of 53.02 (SD, 10.69), out of a total score of 90, and coping styles for cancer (confrontation, avoidance) were closely associated with FOP and reproductive concerns. FOP showed a significant positive correlation with reproductive concerns (r = .52, p < .01). At the same time, confrontation was significantly negatively correlated with both FOP (r = −.28, p < .01) and reproductive concerns (r = −.39, p < .01). Avoidance was positively correlated to both FOP (r = .25, p < .01) and reproductive concerns (r = .34, p < .01). The impact of FOP on reproductive concerns is partially mediated by confrontation and avoidance, with effect sizes of .07 and .04, respectively. These mediating factors account for 22.0% of the total effect. Conclusions The FOP directly impacted reproductive concerns, while coping styles could partially mediate the association between FOP and reproductive concerns. This study illustrates the role of confrontation and avoidance in alleviating reproductive concerns, suggesting that it is necessary to focus on the changes in reproductive concerns among reproductive-age breast cancer patients. Healthcare professionals can improve disease awareness and reduce patients' FOP, thereby promoting positive psychological and coping behaviors and ultimately alleviating reproductive concerns.

This article reported a case of pyruvate dehydrogenase E1-α deficiency suggested by abnormal brain development during prenatal ultrasound imaging. Prenatal ultrasound revealed a mild enlargement of bilateral cerebral ventricles and the possibility of intracranial hemorrhage in the fetus at 25 +1 weeks of gestation. MRI showed the fetus with absent corpus callosum, enlarged bilateral cerebral ventricles and paraventricular cysts. After genetic counseling and careful consideration, the couple opted for pregnancy termination. To clarify the cause of the disease, whole-exome sequencing was performed on the fetal skin to detect possible variants, and which revealed a frameshift mutation c.924_930dup(p.R311Gfs*5) in exon 10 of the PDHA1 gene. Sanger sequencing confirmed the mutation was a de novo pathogenic variant, indicating that the fetus was affected by pyruvate dehydrogenase E1-α deficiency.

Objective:To explore the influencing factors of pregnant women's fear of childbirth.Methods:From January 2020 to February 2021, convenience sampling was used to select pregnant women attending the Department of Gynecology and Obstetrics of Nanjing Integrated Traditional Chinese and Western Medicine Hospital as the research object. The General Information Questionnaire, Edinburgh Postnatal Depression Scale (EPDS) , the Chinese Version of Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A) were used for investigation. Binomial Logistic regression was used to analyze the influencing factors of pregnant women's fear of childbirth. A total of 385 questionnaires were distributed and 359 valid questionnaires were returned.Results:According to the degree of fear of childbirth, 359 pregnant women were divided into mild to moderate fear group ( n=293) and severe fear group ( n=66) . The frequency of pregnancy, infertility treatment, planning pregnancy, whether it is consistent with the expected delivery method, and depression were the influencing factors of pregnant women's fear of childbirth ( P<0.05) . Conclusions:We should focus on pregnant women's fear of childbirth, and carry out interventions for influencing factors.

Objective:To investigate the relationship between the arterial blood lactic acid level after entering the intensive care unit (ICU) and the 28-day mortality of patients with septic shock.Methods:The clinical data of 303 patients with septic shock hospitalized in the department of critical medicine of the Affiliated Hospital of Jining Medical College from April 2015 to June 2019 were analyzed retrospectively. According to the blood lactate (Lac) level, the patients were divided into <4 mmol/L group ( n=203), 4-10 mmol/L group ( n=69) and >10 mmol/L group ( n=31). The baseline characteristics of the patients were analyzed. Multiple logistic regression analysis was used to analyze the independent influencing factors of the 28-day mortality of patients with septic shock. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of the Lac level after entering the ICU for 28-day mortality, and Kaplan-Meier survival curve was performed according to the best cut-off value. Results:A total of 303 patients with septic shock were included, with 179 died in 28 days, and the total mortality was 59.08%. There were 203, 69, 31 patients in Lac<4 mmol/L, 4-10 mmol/L and >10 mmol/L group, respectively. There were significant differences in Acute Physiology and Chronic Health Evalution Ⅱ (APACHE Ⅱ), Sequential Organ Failure Assessment (SOFA), oxygenation index (PaO 2/FiO 2), abdominal infection, the proportion of vasoactive drugs use among the three groups ( P<0.05). Multiple logistic regression analysis showed that the independent influencing factor of the 28-day mortality of septic shock were age, SOFA, use of mechanical ventilation, lactic acid (Lac). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting 28-day mortality of patients with septic shock was 0.604 5 (95% CI: 0.540 8-0.668 2). When the optimal cut-off value was 3.55 mmol/L, the sensitivity was 0.508 4, the specificity was 0.733 9, the positive likelihood ratio was 1.910 3 and the negative likelihood ratio was 0.669 9. According to the best cut-off value of entrance Lac, patients were divided into high Lac group (≥3.55 mmol/L) and low Lac group (<3.55 mmol/L), and their 28-day mortality rates were 73.39%(91/124) and 49.16%(88/179). Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of the high Lac group was significantly lower than that of the low Lac group ( P<0.001). Multiple logistic regression analysis showed that after adjusting for confounding factors, the 28 d mortality increased to 1.22 times for each increase of 1 mmol/L of Lac [odds ratio ( OR)=1.22, 95% confidence interval (95% CI) was 1.08-1.37, P=0.001 4]. The 28 d mortality in high Lac group was 3.53 times higher than that in low Lac group ( OR=3.53, 95% CI was 1.36-7.09, P=0.000 4). Conclusions:In patients with ICU septic shock, the arterial blood Lac level after admission was associated with 28-day mortality. Patients with septic shock whose arterial blood Lac level exceeded 3.55 mmol/L within 1 hour of entering the room had a significantly increased risk of death.

Objective:To investigate the incidence, risk factors and early prognosis of acute kidney injury (AKI) after heart valve surgery in adults, and to provide evidence for the early prevention and treatment of AKI after heart valve surgery.Methods:Clinical data of patients undergoing heart valve surgery from January 2016 to March 2017 were collected retrospectively. Early postoperative AKI was diagnosed and staged according to Kidney Disease Improving Global Outcomes (KDIGO) clinical guidelines for AKI. Patients were divided into AKI group and non-AKI group according to whether AKI occurred within 48 hours after surgery, and the differences in clinical indexes between the two groups were compared and analyzed. Influencing factors for early postoperative AKI were screened by stepwise multivariate logistic regression.Results:A total of 600 patients were enrolled, including 197 patients in the AKI group and 403 patients in the non-AKI group. The incidence of AKI was 32.83%. In the non-AKI and AKI groups, proportion of renal replacement therapy (RRT) during hospitalization, mechanical ventilation time, intensive care unit (ICU) time and proportion of hospital mortality were different (all P<0.001). In the AKI group, 160 patients (81.22%) were in stage I, 33 patients (16.75%) were in stage Ⅱ, and 4 patients (2.03%) were in stage Ⅲ. The proportion of patients receiving RRT, mechanical ventilation time, ICU time, hospital mortality were also different in patients with AKI of different stages (all P<0.05). Logistic regression analysis results showed that males, body mass index≥24.0 kg/m 2, previous history of cardiac surgery, baseline serum creatinine >115 mmol/L, albumin<35 g/L, aortic occlusion time (AOT)>90 min, blood glucose in ICU after operation>11.1 mmol/L, the difference between the highest blood glucose within 48 hours after the operation and the blood glucose at 0 h after the operation≥2 mmol/L, blood lactic acid in ICU after operation>4 mmol/L and maximum vasoactive drug score within 48 hours after surgery>9 were independent influencing factors for early AKI (all P<0.05). Conclusions:The incidence of AKI within 48 hours after heart valve surgery is over 30%. The independent influencing factors include male, overweight/obesity, previous cardiac surgery, preoperative renal insufficiency, hypoproteinemia, long duration of AOT, post-operative stress hyperglycemia, fluctuating blood glucose levels wildly, hyperlactacidemia, and using more vasoactive drugs. AKI after cardiac surgery affects the early prognosis of patients, the later of the stage leads to the worse prognosis.

Objective:To explore the possibility of repairing partial nasal alar defects with individualized design of localized skin flaps.Methods:The clinical data of 38 patients with nasal alar region tumor from October 2015 to June 2019 in Dalian Municipal Central Hospital were retrospectively analyzed, including 5 cases with intradermal nevus, 8 cases with junction nevus, 21 cases with basal cell carcinoma, 3 cases with trichoepithelioma, and 1 case with nasal alar sulcus fistula combined with infection. Surgical treatment with local anaesthesia was applied, and intraoperative freezing pathology was used to confirm the diagnosis and determine the safe margin. There was no nasal alar cartilage infiltration in all patients. The defect areas after resection of nasal alar lesions ranged from 1.0 cm × 1.0 cm to 3.0 cm × 2.5 cm. Local skin flap was aesthetically designed in accordance with the location and size of the nasal alar defect to primarily repair the defect. Among them, 15 cases were repaired with pedicled nasolabial groove flap, 10 cases with modified rhomboid flap, 6 cases with rotatory nasolabial groove flap, 5 cases with V-Y push flap, and 2 cases with double lobe flap.Results:One case had blood transportation obstacle after operation caused by compression and bandaging, 1 case had postoperative infection. Healing of the two cases delayed after treatment, and other patients healed properly. All the flaps survived without facial deformity, and the cosmetic effect was good.Conclusions:The primary repair of the nasal alar defect needs to follow the aesthetic requirements of the nose and face, which varies with diseases and experience of doctors. Flap selection should be individualized to achieve both the purpose of repairing defects and beauty.