Objective:To investigate the clinical characteristics and treatment strategies of toxic epidermal necrolysis(TEN) in children.Methods:The clinical data, laboratory examination, diagnosis and treatment process and treatment outcomes of 11 children with TEN treated in PICU at Children′s Hospital of Xi′an Jiaotong University from January 2018 to June 2022 were collected and analyzed retrospectively.Results:There were five males and six females, aged from one year to 11 years old.Nine cases were caused by drugs, among which six cases were caused by antiepileptic drugs, two cases were caused by Chinese patent medicine, one case was caused by antibiotics, and the remaining two cases were caused by infection.In addition to large area of skin exfoliation, one case was complicated with corneal perforation, one case was complicated with finger (toe) nail fall off, and two cases were complicated with upper airway obstruction.All children were complicated with various degrees of heart, liver, kidney and other organ damage.Eight cases who were admitted to the department of immunology were treated with methylprednisolone and intravenous immune globulin.Three cases had no change in rash, and five cases had an enlarged range of skin lesions compared with admission, and finally all of them were transferred to PICU.Three cases were first diagnosed in PICU and were not treated with methylprednisolone and intravenous immune globulin after admission.All 11 children were given therapeutic plasma exchange in PICU.For children whose first department was PICU, the average hospitalization time of PICU was (8.00±3.00) days, the total average hospitalization time was (33.66±20.10) days, and the average hospitalization cost was (73.9±30.5) thousand yuan.For children whose first department was the immunology department, the average hospitalization time of PICU was (21.62±16.18) days, the total average hospitalization time was (41.87±16.97) days, and the average hospitalization cost was (130.8±52.2) thousand yuan.One case, because of corneal perforation, the family members asked to leave the hospital for economic reasons after the rash improved, and the rest of the children were cured and discharged.Conclusion:TEN is rare, often complicated with multiple organ dysfunction, and has a high mortality.Early administration of therapeutic plasma exchange may alleviate multiple system damage and shorten the duration of disease.

Objective:To investigate the related risk factors affecting the prognosis of hemorrhagic fever with renal syndrome(HFRS) in children.Methods:A retrospective study was carried out.We selected 182 pediatric patients who met the diagnostic criteria for pediatric HFRS while hospitalized in the Intensive Care Department of the Affiliated Children′s Hospital of Xi′an Jiaotong University between July 2014 and December 2021 as the research objects.The severe and critical patients were taken as the observation group(24 cases), and the mild and moderate pediatric patients were taken as the control group(158 cases). The demographic, epidemiological data and clinically relevant indicators within 8 hours of pediatric patients after admission were collected.The 28-day death was the primary endpoint.Renal failure and pulmonary edema were secondary endpoint.The differences of clinically relevant indicators between the two groups were observed.Logistic regression was used to analyze the risk factors and receiver operating characteristic(ROC) curve was used to determine the predictive efficacy of different outcome prediction models.Results:There were no statistically significant differences in age, gender, and BMI between the two groups (all P>0.05). Compared the control group with the observation group, coagulation function indicators such as activated partial thromboplastin time (APTT)[(134±21)s vs.(164±34)s], D-dimer [(6.31±3.20)mg/L vs.(12.43±5.67)mg/L], von Willebrand factor (vWF)[(352±45)μg/L vs.(465±103)μg/L], and platelet(PLT)[(87±35)×10 9/L vs.(45±24)×10 9/L], Lactate(Lac)[(2.6±1.1)mmol/L vs.(6.0±2.0)mmol/L]were different significantly(all P<0.05). Additionally, the lymphocyte characteristic analysis indicator lymphocytes [(2 749±686)×10 6/L vs.(2 374±851)×10 6/L], CD3 + [(1 821± 487)×10 6/L vs.(1 065±539)×10 6/L], CD4 + /CD8 + (1.65±0.73)vs.(1.00±0.25), CD19 + [(559±105)×10 6/L vs.(487± 133)×10 6/L]were different significantly(all P<0.05). The inflammatory index procalcitonin(PCT) [(22±15)ng/L vs.(56±21)ng/L, P<0.05]was different significantly in two groups.The rate of continuous renaly replacement therapy, ventilator-assisted ventilation, vasoactive drugs and other treatment measures increased significantly in observation group than those in control group(all P<0.05). Multivariate logistic regression analysis was performed on the included indicators.With death as the primary endpoint, Lac, CD8 + , D-dimer, vWF and PCT were significantly associated with mortality, which were risk factors for death, while PLT and CD4 + /CD8 + were protective factors.With renal failure and pulmonary edema as secondary endpoint, CD8 + , D-dimer, Lac and PCT were risk factors for secondary endpoint.ROC curve analysis showed that the sensitivity, specificity and AUC of the risk factor prediction model related to the primary endpoint variables were 77.91%, 81.22% and 0.769, and which related to secondary endpoint variables were 87.61%, 77.59% and 0.891, respectively. Conclusion:The combinations of CD8 + , D-dimer, Lac, PCT and vWF have good predictive value for poor prognosis in children with HFRS.

Objective:To investigate the predictive value of central nervous system specific protein B (S100B)combined with neuron specific enolase(NSE)and serum lactate for severe neonatal hypoxic ischemic encephalopathy(HIE)induced by perinatal asphyxia.Methods:A retrospective study was conducted.A total of 126 neonates admitted to the Intensive Care Unit of Children′s Hospital Affiliated to Xi ′an Jiaotong University due to perinatal asphyxia from April 2019 to April 2022 were selected as the research subjects.Neonates who were clinically diagnosed with HIE were selected as the observation group(45 cases), and those without HIE were selected as the control group(81 cases). The differences of each parameter between the two groups were compared.Univariate and multivariate Logistic regression were used to analyze the indicators that might cause severe HIE.The risk factors were put into the receiver operating characteristic curve(ROC)to analyze their predictive value for prognosis.Results:There were no significant differences in gestational age, weight and gender between the two groups(all P>0.05). The Apgar scores in the observation group were lower than those in the control group; the rates of cardiopulmonary resuscitation, mechanical ventilation, and prolonged labor were higher than those in the control group.These differences are statistically significant(all P< 0.05). Compared with the control group, the observation group showed significantly higher rates of abnormal brain electroencephalogram and cranial magnetic resonance imaging, as well as increased levels of lactate, S100B( t-values for 8 h and 72 h were 13.10 and 2.00 respectively), and NSE( t-values for 8 h and 72 h were 10.85 and 15.57 respectively), all with statistical significance(all P< 0.05). By conducting binary Logistic regression analysis on indicators that might cause HIE, it was found that Apgar scores at 5 minutes and 10 minutes were negatively correlated with the risk of severe HIE( OR<1 and P<0.05). Prolonged labor, as well as factors such as cardiopulmonary resuscitation, mechanical ventilation, S100B concentration at 8 hours after birth, NSE concentration at 8 hours after birth, and lactate levels were all risk factors for poor prognosis( OR>1 and P<0.05). The predictive threshold values for severe HIE using the biochemical markers S100B, NSE, and lactate were 1.87 μg/L, 19 μg/L, and 4.6 mmol/L respectively.The sensitivity of prediction were 78%, 68%, and 75% respectively; while the specificity were 66%, 71%, and 67%, and all area under the curve(AUC)was greater than 0.5.The sensitivity of the combined prediction by the three factors was 87%, with a specificity of 79% and AUC 0.86( P<0.05). Conclusion:S100B, NSE and serum lactate are independent risk factors for predicting neonatal serve HIE, and the combination of the three indicators can improve the predictive efficiency.

Objective:To investigate the lymphocyte subsets and clinical characteristics of children with abnormal reaction to Bacillus Calmette-Guérin(BCG)vaccination.Methods:A total of 35 children with BCG disease diagnosed in the Children′s Hospital Affiliated to Xi′an Jiaotong University from January 2013 to December 2019 were enrolled retrospectively.Patients with strong local reaction and lymphadenitis after vaccine injection were selected as the localized group, and with lymphadenitis complicated with distant organ involvement were classified as the disseminated group.The differences in clinical infection indicators, demographic data, lymphocyte subsets and prognosis between the two groups were compared.Results:There are 25 cases in the localized group and 10 cases in the disseminated group, male 20 cases and female 15 cases.Compared with the localized group, the incidence of cough, fever and growth retardation all increased in the disseminated group, with statistical significance(all P<0.05). Lymphocyte ratio[(61.14±18.61)% vs.(39.64±31.45)%], T lymphocytes [CD3 + (×10 6/L): (1 821±487)vs.(1 065±539)], helper/inducible T lymphocytes[CD3 + CD4 + (×10 6/L): (1 058±357)vs.(445±140)], double positive T lymphocytes[CD3 + CD4 + CD8 + (×10 6/L): (24.07±7.17)vs.(14.10±8.89)], CD4 + /CD8 + ratio[CD4 + /CD8 + (%): (1.65±0.73)vs.(1.00±0.25)], natural killer cells[CD16 + CD56 + (×10 6/L): (19.70±2.34)vs.(12.76±7.01)]were lower in the disseminated group than those in the localized group and the differences were significant(all P<0.05). In the disseminated group, 6 cases were diagnosed with immunodeficiency disease and 7 cases died during the follow-up period.All the children in the localized group were cured. Conclusion:Most BCG reaction have a good prognosis, while disseminated children combined with primary immune deficiency have worst prognosis.Early lymphocyte subsets analysis is effective for BCG disease screening.

Pulmonary artery sling (PAS) with bronchial bridge malformation is a very rare developmental malformation of vascular and trachea. In the past 2 years, we treated 3 children with pulmonary artery sling complicated with bronchial bridge, all of whom were clinically characterized by recurrent cough, asthma and dyspnea, which were confirmed by cardiac color ultrasound and chest CT three-dimensional reconstruction. All of the 3 children underwent surgical treatment, and no recurrent wheezing or respiratory tract infection occurred after surgery.

Objective:To explore the application of metagenomics next generation sequencing(mNGS)in the immunosuppressed children with severe pneumonia and to understand the distribution of pathogens in order to provide reference for early prevention and treatment.Methods:We performed a retrospective analysis of the immunosuppressed children with severe pneumonia who had mNGS reports admitted to PICU according with the enrollment condition from July 2019 to July 2020.The records included general clinical data, traditional detection method report and mNGS results.We evaluated the consistency of the mNGS with the clinical microbiology reports and clinical judgment.Results:Twenty-three patients were enrolled, 15 were male and 8 were female, aging from 28 days to 10 years old, with an average age of(3.67±3.20)years old.Seven cases were cured, 2 were improved, and 14 died.A total of 23 samples were obtained, including 21 blood specimens and 2 bronchoal-veolar lavage fluid specimens.Among the 23 cases, 5 were single infected and 15 were mixed infected.Fungi were detected in 15 cases(65.22%), including 12 cases of Pneumocystis jirovecii, 2 cases of Aspergillus fumigatus and 2 cases of Candida albicans.Virus were detected in 14 cases(60.87%), including cytomegalovirus(CMV) in 10 cases(8 cases with pneumocystis infection), Herpes virus in 3 cases and fine ring virus in 2 cases(1 case with herpes virus infection). Bacteria were detected in 10 cases, including 3 cases of Acinetobacter, 1 case of Klebsiella pneumoniae, 1 case of Stenotrophomonas maltophilia, 1 case of Pinocytogenes, 4 cases of Staphylococcus and 1 case of Bacillus licheniformis.There were Mycoplasma in 3 cases with mixed infection.The positive rate and coincidence rate of mNGS were significantly higher than that of the traditional test group( P<0.05). A total of 19 cases were treated with hormone or immunosuppressive agents, and 17 cases were treated for 1 to 6 months when severe pneumonia occurred. Conclusion:Most immunosuppressed children with severe pneumonia are mixed infection.The common pathogens are Pneumocystis jirovecii and CMV.The use of mNGS can significantly improve the pathogen detection rate, effectively guiding the treatment.

Objective:To investigate the correlation between oxygen metabolism index and prognosis of children with severe sepsis.Methods:A retrospective study was conducted.Children with severe sepsis admitted to the Department of Pedaitric Intensive Care Unit, Children′s Hospital Affiliated to Xi′an Jiaotong University from April 2016 to April 2019 were enrolled.Demographic data, hemodynamic-related indexes and oxygen metabolism indexes on admission were collected, and 28-day mortality was our primary outcome.According to the prognosis, the children were divided into survival group and death group.Baseline data, hemodynamic-related indexes and oxygen metabolism indexes on admission were compared between two groups.Binary Logistic regression was used to analyze the risk factors that may affect the prognosis, and relevant risk factors were analyzed by the receiver operator characteristic(ROC)curve to verify the predictability in prognosis.Results:A total of 170 children with severe sepsis were selected, including 79 died in 28-days with a 28-day mortality of 46.47%.There were no statistically significant differences in age, gender( P>0.05). Compared with survival group, the bloodstream infection and intracranial infection incidence were increased in the death group(all P<0.05). Compared with the survival group, blood lactate(Lac) and oxygen extraction ratio(ERO 2) were all increased in the death group[Lac: (7.58±2.64)mmol/L vs.(3.14±1.16) mmol/L, ERO 2: (45.12±11.39)% vs.(32.19±6.24)%, all P<0.05]; Oxygenation index(PO 2/FiO 2), mean arterial pressure(MAP), saturation of arterial blood oxygen(SaO 2), saturation of venous blood oxygen(SvO 2), cardiac index(CI) were all decreased[ PO 2/FiO 2: (237.75±130.37)mmHg vs.(319.25±150.85) mmHg, 1 mmHg=0.133 kPa; MAP: (49±4)mmHg vs.(61±15) mmHg; SaO 2: (62.29±15.16)%vs.(83.21±16.09) %; SvO 2: (57.28±24.02)% vs.(65.32±13.15) %; CI: (1.68±0.76)mL/(min·m 2) vs.(2.56±0.25) mL/(min·m 2), all P<0.05]. The binary Logistic regression showed that Lac and ERO 2 were independent risk factors affecting the prognosis of children with severe sepsis, and the difference was statistically significant[ OR(95% CI) were 2.00(1.14-3.51)and 1.83(1.09-4.05), respectively, all P<0.05]. ROC curve analysis showed that the area under ROC curve of Lac and ERO 2 were 0.675 and 0.789, respectively.Sensitivity to predict death in children with severe sepsis were 93.75% and 85.31%, respectively, whose specificity were 87.85% and 78.39%, respectively.The combined prediction area under ROC curve of Lac and ERO 2 was 0.946, with a sensitivity of 89.15% and specificity of 88.76%, and the differences were statistically significant(all P<0.05). Conclusion:Lac and ERO 2 are independent risk factors affecting children with severe sepsis, and their combination has a good predictive value for the prognosis of children with severe sepsis.

Objective: To systematically review available risk prediction models evidence on construction and verification of colorectal cancer risk prediction models. Methods: "Colorectal neoplasms", "risk assessment", "colorectal cancer", "colorectal tumor", "colon cancer", "colon tumor", "rectal cancer", "rectal tumor", "anal cancer", "anal tumor", "risk prediction", "malignancy", "carcinogenesis", "model" were used as search keywords. Journal papers and grey literature were searched from Chinese electronic databases (CNKI and Wanfang) and English electronic databases (PubMed and Embase) from their inception to 30 Apr 2018. The language of literature was restricted to Chinese and English. The inclusion criteria were human-oriented researches with complete information for model construction,verification and evaluation. The exclusion criteria were informal publications such as conference abstracts, Chinese disertation papers, and non-primary research materials such as reviews,letters,and news reports. Descriptive characteristics,targeted population, study design, model construction method and prediction results were extracted. A total of 36 papers involving 27 models were included. The population characteristics of all included studies,the type of research, the method of model construction and the prediction results of the model were analyzed. Results: As for model construction,there were 13 European and American population based model studies,14 Asian population based model studies,including 7 Chinese mainland based model studies. According to the factors selected into the model, these models can be divided into traditional epidemiological models (17 models), clinical index combined models (4 models),and genetic susceptibility index combined models (6 models). As for model verification,only 9 models were cross-verified in the internal population after model construction, and the extrapolation of model prediction effect was not effectively evaluated; 17 models were verified in an external population; there was only one model verified in two external populations in terms of risk prediction effect; the area under the curve of 27 models was 0.56-0.85. Conclusion The risk prediction model of colorectal cancer is in the development stage. The external evaluation of model prediction effect is less and the prediction ability is not good, and the existing models have limited exploration of clinical indicators.

Objective: To investigate whether elevated levels of C-reactive protein (CRP) and neutrophil (NE) in the blood is associated with an increased risk of lung cancer incidence. Methods: From 2006 to 2007, all employees and retirees from Kailuan (Group) Limited liability Corporation were included in this Kailuan Cohort study. The last follow-up date was December 2015. Data on new cases of lung cancer were collected, and multivariable Cox proportional hazards regression models were used to the relationship between baseline CRP and NE at baseline and risk of lung cancer. Results: A total of 92 735 participants were enrolled in this study. During the follow-up, 850 new cases of lung cancer were identified. All subjects were divided into four groups according to the combination level of CRP and NE at baseline: CRP≤3 mg/L and NE≤4×10⁹/L(Group A), CRP≤3 mg/L and NE>4×10⁹/L(Group B), CRP>3 mg/L and NE≤4×10⁹/L(Group C), CRP>3 mg/L and NE>4×10⁹/L(Group D). The cumulative incidence of lung cancer were 950/100 000, 1 030/100 000, 1 081/100 000 and 1 596/100 000 in these four groups, respectively (P<0.001). Multivariate Cox proportional risk model showed that participants from Group D had an significantly increased 72% risks of lung cancer when compared to Group A (95% CI: 1.40~2.12, P<0.001). Stratified analyses gender showed that males in Group D had higher risk of lung cancer when compared with participants in Group A (HR=1.73, 95% CI: 1.40~2.15, P<0.001). Conclusion Elevated levels of CRP and NE might increase the risk of lung cancer.

Objective To investigate whether elevated levels of C?reactive protein ( CRP ) and neutrophil (NE) in the blood is associated with an increased risk of lung cancer incidence. Methods From 2006 to 2007, all employees and retirees from Kailuan (Group) Limited liability Corporation were included in this Kailuan Cohort study. The last follow?up date was December 2015. Data on new cases of lung cancer were collected, and multivariable Cox proportional hazards regression models were used to the relationship between baseline CRP and NE at baseline and risk of lung cancer. Results A total of 92 735 participants were enrolled in this study. During the follow?up, 850 new cases of lung cancer were identified. All subjects were divided into four groups according to the combination level of CRP and NE at baseline: CRP≤3 mg／L and NE≤4×109／L(Group A), CRP≤3 mg／L and NE＞4×109／L( Group B), CRP＞3 mg／L and NE≤4× 109／L(Group C), CRP＞3 mg／L and NE＞4×109／L(Group D). The cumulative incidence of lung cancer were 950／100 000, 1 030／100 000, 1 081／100 000 and 1 596／100 000 in these four groups, respectively (P＜0.001 ). Multivariate Cox proportional risk model showed that participants from Group D had an significantly increased 72% risks of lung cancer when compared to Group A ( 95% CI: 1.40～2.12, P＜0.001). Stratified analyses gender showed that males in Group D had higher risk of lung cancer when compared with participants in Group A (HR＝1.73, 95% CI: 1.40～2.15,P＜0.001).Conclusion Elevated levels of CRP and NE might increase the risk of lung cancer.