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 explore the effects of graft recipient weight ratio (GRWR) on the early prognosis (within 1 year after operation) of recipients of different ages after split liver transplantation (SLT) in children.Methods:From April 2015 to December 2022, the relevant clinical data were retrospectively reviewed for 188 children aged under 12 years undergoing initial SLT. Based upon operative age, they were assigned into groups of L (age≤18 months, 123 cases) and H (18 months< age≤12 years, 65 cases). Draw receiver operating characteristic (ROC) curves for predicting survival rates in H and L groups using GRWR and determine the cut-off value, and subgroup dassification was based the value. Compare the general condition, intraoperative condition, postoperative condition, and major complications of recipients. Follow-ups were conducted until 12 months post-SLT, death or retransplantation within 12months post-SLT. Kaplan-Meier survival rate analysis was utilized for comparing early postoperative survival rate of recipient/graft. The incidence of major early postoperative complications was examined by χ2 test or Fisher exact probability method. Results:The survival rate of recipients at Month 12 post-SLT was 92.6% (174/188), and graft survival rate was 91.0% (171/188). The survival rate of recipients in group L at Month 12 post-SLT was 94.3% (116/123), and graft survival rate was 92.7% (114/123). The GRWR value determined of 3.1 %. According to the level of GRWR, group L was divided into groups of L-L (GRWR≤3.1%, 36 cases) and L-H (GRWR>3.1%, 87 cases) while group H groups of H-L (GRWR≤3.1%, 55 cases) and H-H (GRWR>3.1%, 10 cases). The survival rates of recipients in groups L-L/L-H were 88.9% (32/36) and 96.6% (84/87) at Month 12 post-SLT. Inter-group difference was not statistically significant ( P=0.077). Graft survival rates were 83.3% (30/36) and 96.6% (84/87 ). Inter-group difference was statistically significant ( P=0.007). The intraoperative cold ischemia time were 479.0 (194.0, 593.0) min and 204.0 (122.0, 495.0) min in groups L-L/L-H. Inter-group difference was statistically significant ( P=0.002 ). The incidence of hepatic artery thrombosis were 13.9 % (5/36) and 2.3 % (2/87) in groups L-L/L-H. Inter-group difference was statistically significant ( P=0.036). The survival rate of recipients in group H at Month 12 post-SLT was 89.2% (58/65), and graft survival rate was 87.7% (57/65). No significant inter-group difference existed during surgery ( P>0.05 ). The survival rates of recipients in group H-L/H-H at Month 12 post-SLT were 92.7 % (51 /55) and 70.0 % (7/10 ). Inter-group difference was statistically significant ( P=0.019). Graft survival rates were 90.9% (50/55) and 70.0% (7/10). Inter-group difference was statistically significant ( P=0.036). No significant inter-group difference existed in the incidence of complications ( P>0.05) . Conclusion:During pediatric SLT, recipients of different ages have different requirements for GRWR. GRWR≤3.1 % implies poor early prognosis of recipients aged ≤18 months and GRWR>3.1% is associated with poor early prognosis of recipients aged between 18 months and 12 years.

Objective:To explore the risk factors and treatments of portal vein thrombosis (PVT) in children after pediatric living donor liver transplantation (pLDLT) .Method:From January 2014 to December 2021, the relevant clinical data were retrospectively reviewed for 975 LDLT children at Department of Pediatric Organ Transplantation of Tianjin First Central Hospital. Based upon the postoperative occurrence of PVT, they were assigned into two groups of PVT (19 cases) and non-PVT (956 cases). Univariate and multivariate analyses were performed for screening the risk factors of PVT post-LDLT and discussing the managements and prognoses of PVT.Result:Among them, overall incidence of PVT post-LDLT was 1.9% (19/975), and median time for an initial occurrence of PVT 8 (1-495) day. Single-factor analysis indicated that donor height ( P=0.014), operative duration ( P=0.002) and vascular interposition ( P=0.001) were correlated with the occurrence of postoperative PVT post-pLDLT. Multifactorial analysis revealed that operative duration ( P=0.008) and vascular interposition ( P<0.01) were independent risk factors for PVT post-pLDLT. For 19 cases of postoperative PVT, the measures included surgical thrombectomy (8 cases), urokinase thrombolysis plus warfarin anticoagulation (3 cases), interventional treatment (3 cases), warfarin anticoagulation (4 cases) and retransplantation (1 cases). After treatment, the outcomes were a disappearance of PVT (15 cases), symptomatic improvement (2 cases) and unrelated mortality (2 cases) . Conclusion:During pLDLT, intraoperative placement of blood vessels and operative duration are independent risk factors for the occurrence of PVT. Timely standardized treatment may achieve satisfactory therapeutic outcomes.

OBJECTIVE: To compare the long-term survival outcomes of Siewert II adenocarcinoma of esophagogastric junction (AEG) between transthoracic (TT) approach and transabdominal (TA) approach. METHODS: The databases of Gastrointestinal Surgery Department and Thoracic Surgery Department in West China Hospital of Sichuan University from 2006 to 2014 were integrated. Patients of Siewert II AEG who underwent resection were retrospectively collected. INCLUSION CRITERIA: (1) adenocarcinoma confirmed by gastroscopy and biopsy; (2) tumor involvement in the esophagogastric junction line; (3) tumor locating from lower 5 cm to upper 5 cm of the esophagogastric junction line, and tumor center locating from upper 1 cm to lower 2 cm of esophagogastric junction line; (4)resection performed at thoracic surgery department or gastrointestinal surgery department; (5) complete follow-up data. Patients at thoracic surgery department received trans-left thoracic, trans-right thoracic, or transabdominothoracic approach; underwent lower esophagus resection plus proximal subtotal gastrectomy; selected two-field or three-field lymph node dissection; underwent digestive tract reconstruction with esophagus-remnant stomach or esophagus-tubular remnant stomach anastomosis above or below aortic arch using hand-sewn or stapler instrument to perform anastomosis. Patients at gastrointestinal surgery department received transabdominal(transhiatal approach), or transabdominothoracic approach; underwent total gastrectomy or proximal subtotal gastrectomy; selected D1, D2 or D2 lymph node dissection; underwent digestive tract reconstruction with esophagus-single tube jejunum or esophagus-jejunal pouch Roux-en-Y anastomosis, or esophagus-remnant stomach or esophagus-tubular remnant stomach anastomosis; completed all the anastomoses with stapler instruments. The follow-up ended in January 2018. The TNM stage system of the 8th edition UICC was used for esophageal cancer staging; survival table method was applied to calculate 3-year overall survival rate and 95% cofidence interval(CI); log-rank test was used to perform survival analysis; Cox regression was applied to analyze risk factors and calculate hazard ratio (HR) and 95%CI. RESULTS: A total of 443 cases of Siewert II AEG were enrolled, including 89 cases in TT group (with 3 cases of transabdominothoracic approach) and 354 cases in TA group. Median follow-up time was 50.0 months (quartiles:26.4-70.2). The baseline data in TT and TA groups were comparable, except the length of esophageal invasion [for length <3 cm, TA group had 354 cases(100%), TT group had 44 cases (49.4%), χ²=199.23,P<0.001]. The number of harvested lymph node in thoracic surgery department and gastrointestinal surgery department were 12.0(quartiles:9.0-17.0) and 24.0(quartiles:18.0-32.5) respectively with significant difference (Z=11.29,P<0.001). The 3-year overall survival rate of TA and TT groups was 69.2%(95%CI:64.1%-73.7%) and 55.8% (95%CI:44.8%-65.4%) respectively, which was not significantly different by log-rank test (P=0.059). However, the stage III subgroup analysis showed that the survival of TA group was better [the 3-year overall survival in TA group and TT group was 78.1%(95%CI:70.5-84.0) and 46.3%(95%CI:31.0-60.3) resepectively(P=0.001)]. Multivariate Cox regression analysis revealed that the TT group had poor survival outcome (HR=2.45,95%CI:1.30-4.64, P=0.006). CONCLUSION The overall survival outcomes in the TA group are better, especially in stage III patients, which may be associated with the higher metastatic rate of abdominal lymph node and the more complete lymphadenectomy via TA approach.
Adenocarcinoma ; classification ; mortality ; pathology ; surgery ; China ; Databases, Factual ; Esophageal Neoplasms ; classification ; pathology ; surgery ; Esophagectomy ; methods ; Esophagogastric Junction ; pathology ; surgery ; Gastrectomy ; methods ; Humans ; Laparotomy ; Lymph Node Excision ; methods ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms ; classification ; mortality ; pathology ; surgery ; Survival Analysis ; Thoracic Surgical Procedures

Objective: To investigate the difference in intestinal microbiome between children with atopic dermatitis (AD) and healthy children. Methods: Totally, 35 children with AD were enrolled from the Department of Dermatology, Jiading Hospital of Traditional Chinese Medicine from April 2015 to April 2017, and 27 healthy children served as control group. Total DNA was extracted from the feces of the subjects, and the V3-V4 region of the 16S rRNA gene of the bacteria was amplified by PCR. High-throughput sequencing was performed using the Illumina Miseq sequencing platform to analyze the diversity of bacterial flora. The top 15 abundant bacteria were determined at phylum, genus, and species levels, and compared between the two groups. Statistical analysis was carried out using Wilcoxon rank sum test. Results: The intestinal microbiome in the two groups mainly consisted of Firmicutes, Bacteroidetes, Proteobacteria and Actinobacteria. At the phylum level, the abundance of Bacteroidetes and Fusobacteria was significantly lower in the AD group (29.16% ± 19.96%, 0.06% ± 0.17%, respectively) than in the healthy control group (39.06% ± 15.98%, 0.50% ± 1.71%, respectively, P = 0.042, 0.041) . At the genus level, the abundance of Bacteroides was significantly lower in the AD group (23.77% ± 18.08%) than in the healthy control group (33.1% ± 15.75%, P = 0.029) . There was no significant difference in the distribution of the top 15 abundant species between the two groups (all P > 0.05) . Conclusion There are some differences in the composition of intestinal microbiome and relative abundance of bacteria between children with AD and healthy children.

Objective To investigate the psychological resilience in breast cancer patients undergoing radiotherapy, and analyze its influencing factors. Methods A total of 120 cases of breast cancer patients undertaking radiation therapy in the radiation department of a ClassⅢ Grade A hospital from January to December 2017 were collected by convenience sampling method. General information questionnaire, the Chinese version of Connor-Davidson Resilience Scale (CD-RISC) and Perceived Social Support Scale (PSSS) were applied to investigate patients. Single factor analysis, Pearson correlation analysis and multiple linear regression analysis were used to analyze the influencing factors of psychological resilience in patients with breast cancer undergoing radiotherapy. Results A total of 112 valid questionaires were collectod. The total score of psychological resilience of breast cancer patients was (50.31±12.53), and the scores of self-strengthening, tenacity and optimism were (17.23±3.53), (24.63±6.84) and (8.93±2.32) respectively. Age, education level, presence of complications, and perceived social support are the main factors affecting patients' psychological resilience. Conclusions Psychological resilience of breast cancer patients was at the moderate level. Medical staff should give more targeted interventions according to the specific conditions of patients, provide more social support for patients, and improve the psychological resilience of patients.

OBJECTIVETo compare the postoperative analgesia efficacy, rehabilitation parameters and complication between multimodal analgesia and traditional analgesia after radical gastrectomy for gastric cancer patients.

METHODSPatients with gastric cancer who underwent surgery in our hospital from October 2016 to December 2016 were enrolled in this prospective study. According to the non-randomized method, patients were assigned to multimodal analgesia group(n=32) and traditional analgesia group(n=33) in gastric cancer treatment team A and B in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. The treatment measures of group A were as follows: (1) The ratio of 1/1 diluted ropivacaine (100 mg, 10 ml) was infiltrated around the incision before abdomen closure, with incision sutured layer by layer. (2) Parecoxib sodium (40 mg) was injected intravenously every 12 hours after operation for 5 days. (3) Oxycodone-acetaminophen tablet was given orally on the first day or the second day after operation, 50 mg twice a day. (4) Patient-controlled analgesia was not used after operation. Patients in group B received direct suture of incision and patient-controlled analgesia. The pain score, postoperative rehabilitation and 30-day postoperative complications were collected and analyzed.

RESULTSMultimodal analgesia group had lower pain scores at 1 d (4.8±0.9), 2 d (4.3±1.0), 3 d (2.9±0.8), 4 d (2.4±0.7) and 5 d (1.7±0.7) after surgery, as compared to traditional analgesia group (5.9±0.9, P=0.000), (5.1±0.7, P=0.001), (3.9±0.8, P=0.000), (3.0±0.6, P=0.000), (2.6±0.7, P=0.000), with significant difference. Postoperative hospital stay [(8.2±1.6) days vs. (10.6±2.2) days, P=0.000], time to ambulation [(47.5±13.8) days vs. (66.2±16.8) days, P=0.000], time to first flatus [(76.4±25.2) days vs. (120.0±29.9) days, P=0.000], time to first defecate [(117.3±42.2) days vs. (159.7±30.7) days, P=0.000] and time to first fluid diet [(83.8±21.6) days vs. (141.9±33.9) days, P=0.000] in the multimodal analgesia group were significantly shorter than those in the traditional analgesia group. There was no significant difference between the two groups with respect to 30-day postoperative complication rate(9.4% vs. 9.1%, P=1.000).

CONCLUSIONSMultimodal analgesia can significantly reduce the postoperative pain and is beneficial to rehabilitation, meanwhile it does not increase the risk of postoperative complications. Multimodal analgesia is safe and effective for gastric cancer patients undergoing radical gastrectomy.

Acetaminophen ; administration & dosage ; therapeutic use ; Amides ; administration & dosage ; therapeutic use ; Analgesia, Patient-Controlled ; China ; Comparative Effectiveness Research ; Defecation ; Drug Combinations ; Eating ; Flatulence ; Gastrectomy ; rehabilitation ; Humans ; Isoxazoles ; administration & dosage ; therapeutic use ; Length of Stay ; statistics & numerical data ; Oxycodone ; administration & dosage ; therapeutic use ; Pain Management ; methods ; Pain, Postoperative ; drug therapy ; Postoperative Complications ; Prospective Studies ; Recovery of Function ; drug effects ; Stomach Neoplasms ; surgery ; Surgical Wound ; rehabilitation ; therapy ; Suture Techniques ; Treatment Outcome ; Walking

Objective To explore the relationship between sudomotor function and peripheral artery disease (PAD),and to evaluate the effectiveness of sudomotor function testing to screen diabetic patients at high risk of PAD comparing to ankle-brachial index (ABI) and toe-brachial index (TBI).Methods A total of 263 diabetes mellitus (DM) outpatients in the 306th Hospital of PLA from August 2014 to April 2015 were enrolled in the study.ABI and TBI were measured by the Doppler method.Sudomotor function was evaluated by measuring the electrochemical skin conductance (ESC) of the hands and feet using the Sudoscan instrument.Cardiovascular autonomic neuropathy (CAN) was assessed and recorded as cardiac autonomic neuropathy risk-score (CAN-RS) by Sudoscan.Results ESC values of the feet and hands were positively correlated with ABI and TBI.The diabetes patients with abnornal ABI and TBI had significantly lower hand ESC [(45.63±12.87) μS vs.(68.10±17.40) μS,(59.17±19.58) μS vs.(68.57±17.11) μS;P＜ 0.05] and feet ESC [(44.54±25.48) μS vs.(70.92±19.46) μS,(59.21±24.52) μS vs.(71.71±19.02) μS;P＜ 0.05],and higher CAN-RS[(49.17± 15.41)％ vs.(36.33±16.25)％,(44.90±16.09)％ vs.(35.39±16.05)％;P＜ 0.05],than diabetes patients with normal ABI and TBI.Using ABI as the gold standard,the areas under the receiver operating characteristics (ROC) curve of the diagnostic performance of hands ESC,feet ESC and CAN-RS to identify PAD were 0.87,0.84 and 0.74,respectively (P＜0.001).Conclusion Sudomotor function testing can be helpful and beneficial to identify PAD in patients with diabetes.

Background:Whether the ABO blood group is associated with the survival of patients with laryngeal cancer remains unknown. The purpose of this study was to investigate the association between the ABO blood group and clinico?pathologic characteristics of patients with laryngeal cancer and assess whether the ABO blood group was associated with prognosis. Methods:We analyzed the records of 1260 patients with laryngeal cancer who underwent curative treatment at Sun Yat?sen University Cancer Center between January 1993 and December 2009. The Chi?square test was used to assess the relationship between the ABO blood group and clinicopathologic characteristics. The Kaplan–Meier method was used to estimate 3?, 5?, and 10?year overall survival (OS) rates. The Cox proportional hazards model was used in univariate and multivariate analyses of OS. Results:No signiifcant association was found between the ABO blood group and clinicopathologic characteristics except for primary tumor site. The median OS for patients with blood groups A, B, AB, and O were 87.0, 80.0, 90.0, and 72.5months, respectively. The 3?, 5?, and 10?year OS rates were 82.4%, 76.0%, and 67.5% for patients with blood group A; 77.4%, 69.8%, and 58.4% for patients with blood group B; 82.2%, 73.1%, and 65.6% for patients with blood group AB; and 71.7%, 66.4%, and 55.5% for patients with blood group O, respectively. Univariate and multivariate analyses showed that the ABO blood group had signiifcant effects on prognosis in patients with laryngeal cancer. Conclusions:The ABO blood group is associated with survival in patients with laryngeal cancer. Patients with blood group O had signiifcantly shorter OS than patients with other ABO blood groups.

Objective To explore the clinical significance of PET-CT in evaluating distant metastasis and M staging of nasopharyngeal carcinoma(NPC). Methods 257 NPC patients with no prior treatment were investigated with PET-CT and conventional imaging (chest X-ray, abdominal ultrasound, and bone scan). The findings of PET-CT in diagnosing distant metastasis and M staging were compared with those of conventional imaging according to the results of biopsy and follow-up. Results PET-CT disclosed 34 of 39 patients with distant malignancy compared with 22 patients disclosed by conventional imaging. The false positive rate of PET-CT was 12.8 %. On region-based analyses, PET-CT was more effective than bone scan and chest X-ray for detecting mediastinum metastasis (x2=4.063, P =0.041) and bone metastasis (x2=5.939, P=0.015), respectively. Compared with conventional imaging, PET-CT had an impact on the M staging of 19 patients (7.4 %), of which 15 patients were truly staged and 4 patients incorrectly staged. Conclusion PET-CT is superior to MRI in evaluating distant metastasis and M staging of NPC.