Background:Human bocavirus 1 (HBoV1) is a common pediatric respiratory virus, yet, its potential to cause severe systemic illness as a sole pathogen and its specific effects on the urinary system are not fully recognized. This report describes the first case of pediatric sepsis, meeting the 2024 Phoenix sepsis criteria, caused by high-load HBoV1 viremia, which was characterized by a novel triphasic urinary course. Case Description:A previously healthy 4-year-old girl presented with fever and cough and developed asymptomatic sterile pyuria on illness day 4. On day 7, her condition deteriorated to sepsis (Phoenix Sepsis Score of 2), with acute respiratory distress and a depressed level of consciousness. Blood metagenomic next-generation sequencing (mNGS) identified high-load HBoV1 viremia (7,513 reads) as the sole pathogen, with negative blood and urine cultures. During the septic peak, urinary tract ultrasonography was normal; however, follow-up imaging on day 13 revealed delayed-onset, non-obstructive pyelectasis and increased post-void residual (PVR) volume. These functional abnormalities were resolved completely within 2.5 months. Conclusions:HBoV1 can act as a sole pathogen to cause pediatric sepsis. The observed triphasic urinary course-early sterile pyuria, imaging quiescence at the sepsis peak, and delayed functional impairment-supports an inflammation-mediated pathogenesis rather than direct viral invasion. This case highlights the critical role of advanced molecular diagnostics in identifying viral etiologies in culture-negative sepsis and underscores the necessity of longitudinal functional surveillance, as clinically significant organ dysfunction may manifest after the acute inflammatory phase has resolved.

This study investigates the value of myocardial work indices (MWI) in quantitatively assessing left ventricular systolic dysfunction (LVSD) in patients with sepsis-induced cardiomyopathy (SICM-LVSD) and in predicting outcomes in sepsis. In this prospective cohort study, 180 patients were categorized into sepsis and SICM groups based on echocardiographic findings. The patients further divided into survival and event groups based on the 28 days prognosis. The study assessed the diagnostic and prognostic value of MWI and various conventional echocardiographic parameters, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), global longitudinal strain (GLS), and left ventricular ejection fraction(LVEF). Univariate and multivariate logistic regression analyses were performed to investigate the diagnostic value of MWI parameters for SICM-LVSD and their prognostic efficacy. MWI were significantly impaired in the SICM and event groups, with GWI, GCW, and GWE being significantly lower, while GWW was higher in the SICM compared to the sepsis group (all P < 0.01). GLS demonstrated the highest diagnostic value for SICM-LVSD (AUC = 0.81), followed by GWI and GCW (AUC = 0.77 for both). In terms of prognosis, GWI, GCW, GLS, and GWE were the most effective predictors of adverse events (AUC values of 0.75, 0.74, 0.72, and 0.70, respectively). MWI can accurately assess LVSD in patients with SICM. GLS, GWI, and GCW demonstrate high diagnostic efficacy. While GWI, GCW, and GWE provide superior prognostic value for 28-day outcomes compared to traditional measures like LVEF. MWI represents a promising new echocardiographic approach that integrates myocardial strain with afterload, offering a more physiologic evaluation of myocardial performance.

Abstract Before November 2023, CD19 chimeric antigen receptor (CAR) T-cell therapies had not been approved in China for patients with relapsed or refractory B-cell acute lymphoblastic leukemia (R/R B-ALL), leaving a significant unmet need. In response, inaticabtagene autoleucel (Inati-cel), a novel CD19 CAR T-cell therapy with a distinct single-chain variable fragment (HI19α), was developed and showed promising efficacy in preliminary clinical research. We conducted a phase 2, single-arm, multicenter study of Inati-cel in adult CD19+ R/R B-ALL in China. The primary end point was the overall remission rate (ORR) at the end of month 3. Forty-eight patients who underwent Inati-cel infusion were evaluated for both efficacy and safety. Among them, 34 patients achieved and maintained remission beyond 3 months, with a 3-month ORR of 70.8% (95% confidence interval [CI], 55.9-83.1). The best ORR was 85.4%, with all responders reaching minimal residual disease negativity. With a median follow-up of 23.7 months, the median duration of remission was 20.7 months (95% CI, 6.4 to not reached), and the median overall survival was not reached (95% CI, 13.0 months to not reached). Additionally, grade ≥3 cytokine release syndrome and neurologic events occurred in 12.5% and 6.2% of patients, respectively. The 2-year follow-up data suggest that Inati-cel demonstrates encouraging and durable responses with manageable safety profiles in R/R B-ALL. Based on the data from this pivotal trial, Inati-cel was approved as the first CAR T-cell therapy for adult R/R B-ALL in China and underscores its potential therapeutic benefits for this patient population. This trial was registered at www.ClinicalTrials.gov as #NCT04684147.

Metabolic dysfunction-associated steatotic liver disease is increasingly affecting younger populations. Ultrasound-derived fat fraction is a technique used in ultrasound to quantify liver fat content. The diagnostic performance of ultrasound-derived fat fraction in pediatric patients with metabolic dysfunction-associated steatotic liver disease is yet to be evaluated. To evaluate the diagnostic performance of ultrasound-derived fat fraction measurement in detecting and grading hepatic steatosis in pediatric patients with metabolic dysfunction-associated steatotic liver disease. In this prospective study, pediatric patients diagnosed with metabolic dysfunction-associated steatotic liver disease were enrolled. Six acquisitions of ultrasound-derived fat fraction were obtained. Taking magnetic resonance imaging (MRI)-proton density fat fraction as a reference standard, the area under the receiver operating characteristic curve (AUC) was performed to evaluate the diagnostic performance of ultrasound-derived fat fraction. Youden index was used to determine the cutoff value of ultrasound-derived fat fraction. Correlation coefficient and Bland–Altman plot were performed. From April 2024 to March 2025, 32 patients (median age, 12 years; median body mass index, 29.7 kg/m2) were included. The ultrasound-derived fat fraction values showed a positive correlation with MRI-proton density fat fraction (r = 0.72). The ultrasound-derived fat fraction values and MRI-proton density fat fraction had a mean bias of 3.3

INTRODUCTION:This study aimed to evaluate the predictive accuracy of baseline lactate levels and the modified age-adjusted quick Sequential Organ Failure Assessment (qSOFA) score in forecasting mortality in critically ill pediatric patients. METHODS:A retrospective single-center analysis was conducted on patients aged ≤18 years admitted to the intensive care unit (ICU) between January 1, 2019, and December 31, 2023. The predictive performance of lactate levels at baseline and that of the modified age-adjusted qSOFA score were compared in terms of mortality. RESULTS:Among 1156 patients (median age: 20.2 months; mortality rate: 6.2 %), non-survivors exhibited significantly higher baseline lactate levels (3.7 [2.4-4.9] vs. 2.1 [1.4-3.4] mmol/L, *p* < 0.01) and modified age-adjusted qSOFA scores (3 (Bulgarelli et al., 2020; Filho et al., 2016a; Issa et al., 2021) vs. 1 [0-2], *p* < 0.01) compared to survivors. The baseline lactate level exhibited a predictive value of 0.699(sensitivity: 59.7 %; specificity: 74.9 %). The modified age-adjusted qSOFA score showed greater predictive capability than baseline lactate levels in critically ill pediatric patients; nevertheless, it is constrained by limited specificity. The predictive value of baseline lactate level paired combined with the modified age-adjusted qSOFA score was similar to that of the modified age-adjusted qSOFA score alone. Specifically, when the area under the Receiver Operating Characteristic (ROC) curve reached 0.836, the specificity enhanced with the integration of these two indicators. However, lactate levels and the modified age-adjusted qSOFA score did not influence clinical decision-making in critically ill pediatric patients, as demonstrated by subgroup analysis according to different baseline lactate concentrations. CONCLUSION:Baseline lactate and the modified age-adjusted qSOFA score had a low-accuracy ability to predict mortality in critically ill children. Although the combination of lactate and the modified age-adjusted qSOFA score appears to enhance predictive ability, it remains an insufficient predictor for making definitive clinical decisions in critically ill children.

Background:Aortic dissection is rare in both children and adults. Misdiagnosis is common because of hidden symptoms, insufficient knowledge among pediatricians, and lack of consensus and guidelines. We aimed to report the clinical features of patients and enhance the diagnostic awareness of aortic dissection in children with acute chest pain or trauma, avoid delayed diagnosis and the subsequent worsening of clinical outcomes. Case Description:We presented three cases of pediatric aortic dissection and summarized our findings from the literature. We treated a 13-year-old boy with Stanford Type A aortic dissection, a 9-year-old boy with Stanford Type B aortic dissection, and an 11-year-old boy with Stanford Type A aortic dissection. Two patients had spontaneous aortic lesions, one had a traumatic aortic lesion, and all three were discharged from our hospital after thoracotomy. We searched the Medline database using PubMed and platforms such as Springer Link and Google Scholar with the search terms "aortic dissection" and "pediatric" or "children". We retrieved 27 reports describing 34 cases of aortic dissection in patients aged ≤16 years published from 1990 to 2024 to summarize the characteristics of precipitating factors, aortic dissection status, and clinical presentations. Conclusions:The prognosis of children with aortic dissection after treatment is generally better than that of adults. In pediatric emergency settings, persistent chest pain that does not alleviate and cannot be attributed to common illnesses warrants heightened suspicion of aortic dissection. Surgical treatment should be promptly performed once the condition is diagnosed.

Objective:Metabolic heterogeneity in sepsis is a critical determinant of prognosis. This study applied group-based trajectory modeling (GBTM) to identify blood glucose trajectory phenotypes in pediatric sepsis and elucidate their associations with clinical outcomes. Methods:A retrospective cohort study was conducted, enrolling 1,178 pediatric patients diagnosed with sepsis who were admitted to the pediatric intensive care unit of the Children's Hospital of Chongqing Medical University between 2014 and 2022. Dynamic blood glucose data were collected within 72 h of ICU admission, and GBTM was employed to classify trajectory phenotypes. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality. A subgroup analysis focused specifically on patients with septic shock. Results:The analysis identified four distinct blood glucose trajectory phenotypes: Group 1 (7.3%): Slow-recovery hypoglycemia, predominantly among infants with severe liver injury, coagulopathy, and hyperlactatemia (in-hospital mortality: 13.79%). Group 2 (59.9%): Normoglycemia with minimal organ dysfunction (reference group; mortality: 5.10%). Group 3 (27.7%): Persistent mild hyperglycemia, characterized by elevated inflammatory markers and mild organ injury (mortality: 8.26%). Group 4 (4.9%): Persistent severe hyperglycemia associated with renal impairment and lactate accumulation (mortality: 17.24%). Multivariate analysis revealed Group 4 as an independent risk factor for mortality (aOR = 3.13, 95% CI 1.38-7.07). In the septic shock subgroup, the mortality risks for Group 1 and Group 4 increased by 5.2-fold and 8.28-fold, respectively (both P < 0.05). Conclusion:GBTM effectively stratifies pediatric sepsis into distinct blood glucose trajectory phenotypes. Persistent severe hyperglycemia (Group 4) independently predicts in-hospital mortality, while slow-recovery hypoglycemia (Group 1) indicates a poor prognosis in septic shock. Phenotype-guided interventions are recommended: early insulin therapy (target blood glucose <10 mmol/L) for Group 4 and prophylactic glucose infusion (target >3.8 mmol/L) for Group 1.

ObjectiveTo investigate the efficacy and potential adverse events of Tuina therapy for idiopathic constipation in children with cerebral palsy (CP).MethodsA total of 60 CP children with idiopathic constipation were enrolled and randomly divided into Tuina and control groups. The control group was treated with basic treatment and 12 sessions of lactulose oral solution, whereas the Tuina group received basic treatment and 12 sessions of infantile Tuina treatment. The following parameters were compared: the Bristol stool form scale (BSFS), the Constipation Assessment Scale (CAS) and the improvement in constipation. In addition, adverse effects were recorded.ResultsAt 4 weeks after the final treatment, the percentage of infants whose constipation improved was 23 (76.7%) in the Tuina group and 21 (70.0%) in the control group (P = 0.771). Initially, the CAS score, weekly bowel movements and proportion of infants with bowel evacuation ≥2 h were comparable between the two groups (P > 0.05). At 4 weeks after the final treatment, the CAS score, weekly bowel movements and proportion of infants with bowel evacuation ≥2 h all significantly improved (P < 0.05) compared with those in the initial situation. However, no difference was found in either group at 4 weeks after the final treatment. No serious adverse reactions (such as diarrhea, abdominal pain, vomiting, subcutaneous redness, skin breakage, or syncope) were recorded.ConclusionsTuina was as effective as medical care in addition to basic treatment for both groups. The results of this study suggest that Tuina, as a nonpharmacological therapy, may be helpful as an alternative treatment for constipation. More advanced research and large-sample studies should be conducted.

OBJECTIVE:To analyze the clinical characteristics and prognosis of children with hematological malignancies complicated by secondary hemophagocytic lymphohistiocytosis (HLH). METHODS:A total of 67 children with HLH admitted to Jinan Second Maternal and Child Health Hospital between June 2020 and June 2024 were selected. Children without hematological malignancies were divided into the non-combined group, and those with hematological malignancies were divided into the combined group. The clinical characteristics and prognosis of the two groups were analyzed. RESULTS:There were no significant differences in clinical characteristics such as WBC, Hb, PLT between the two groups (P ＞0.05). During the follow-up, the 1- and 2-year overall survival (OS) rates for all children were (88.6±4.1)% and (73.1±7.7)%, respectively. In the non-combined group, 43 children survived and 6 died, with 1- and 2-year OS rates of (95.2±3.3)% and (77.4±9.3)%, respectively. In the combined group, 12 children survived and 6 died, with 1- and 2-year OS rates of (71.8±10.7)% and (62.8±12.6)%, respectively. The OS rate of the combined group was significantly lower than that of the non-combined group (χ2=4.787, P =0.029). The 1- and 2-year event free survival (EFS) rates of the combined group were (61.1±11.5)% and (50.9±13.3)%, respectively. CONCLUSION:Children with hematological malignancies complicated by secondary HLH exhibit complex and diverse clinical characteristics. Although favorable short-term therapeutic effects can be achieved, their long-term prognosis tends to be less optimistic.

Background: Diarrhea during enteral nutrition may induce various complications and increase the nursing workload. Local Problem: The diarrhea rate in our intensive care units (ICUs) was 37.14% from May to July 2021. Nurses reported a moderate to heavy burden regarding care for those with diarrhea. Methods: A pre-post implementation design was used to evaluate the impact of evidence-based interventions for diarrhea screening and prevention. Interventions: A diarrhea risk screening tool and countermeasures were developed through an extensive literature review. Tools were integrated into the electronic health record system. Results: The rate of diarrhea decreased from 37.14% to 17.33% (P = .000). Nurse's compliance with practice standards increased for diarrhea assessment, risk factor screening, agent choice, and countermeasures provision (P < .05). Conclusions: The evidence-based tools developed for this project helped decrease the diarrhea rate in our ICUs.

"Prone Positioning Improved Ventilation-Perfusion Matching in Severe Pediatric Acute Respiratory Distress Syndrome." American Journal of Respiratory and Critical Care Medicine, 207(10), pp. e75–e76

Parenteral nutrition, received by many patients with intestinal failure, can induce hepatobiliary complications, which is termed as parenteral nutrition-associated liver disease (PNALD). The spectrum of PNALD ranges from cholestasis and steatosis to fibrosis and cirrhosis. Although many factors contribute to the pathogenesis of PNALD, the underlying mechanisms remain unclear. In this study, we performed targeted metabolomics to characterize the metabolomic profile in neonatal piglets receiving total parenteral nutrition (TPN) or enteral nutrition (EN) for 1 or 2 weeks. Overall, the metabolomic signature of TPN groups differed from EN groups at both time points. Among the 20 acylcarnitines identified, a majority of them were significantly reduced in TPN groups. KEGG pathway analysis showed that phenylalanine metabolism-associated pathways were dysregulated accompanied by more progressive liver steatosis associated with TPN. Next, we evaluated phenylalanine catabolism and its association with fatty acid oxidation in piglets and rats with PNALD. We showed that the hepatic expression of phenylalanine-degrading enzyme phenylalanine hydroxylase (PAH) was reduced and systemic phenylalanine levels were increased in both animal models of PNALD. Moreover, carnitine palmitoyltransferase 1A, a central regulator of fatty acid oxidation, was downregulated and its expression was negatively correlated with phenylalanine levels in TPN-fed animals. To explore the effects of phenylalanine accumulation on lipid metabolism, we treated HepG2 cells with phenylalanine co-cultured with sodium palmitate or soybean oil emulsion to induce lipid accumulation. We found that phenylalanine treatment exacerbated lipid accumulation by inhibiting fatty acid oxidation without affecting fatty acid synthesis. In summary, our findings establish a pathogenic role of increased phenylalanine levels in driving liver steatosis, linking dysregulation of phenylalanine catabolism with lipid accumulation in the context of PNALD.

BACKGROUND:Pediatric intestinal pseudo-obstruction (PIPO) is a heterogeneous and severe group of disorders with a high mortality rate. Patients with PIPO often develop malnutrition and need long-term nutrition support. This study aimed to determine the nutrition status, particularly micronutrients, during the long-term follow-up of patients with PIPO.METHODS:Fifty-eight patients with PIPO were followed up for at least 6 months between January 2008 and December 2020 in our hospital. PIPO was diagnosed based on the European society for pediatric gastroenterology, hepatology, and nutrition consensus. Data on clinical characteristics, medical and surgical management, nutrition support, serum vitamins, and mineral concentrations were collected. The patients were divided into the early-onset PIPO (EO-PIPO; neonatal-onset) and late-onset PIPO (LO-PIPO; infant- or child-onset) groups.RESULTS:The mean follow-up was 29.5 months (6-153 months). The overall survival rate was 63.8% (37 out of 58 participants) (EO-PIPO, 48.6% [17 out of 35 participants]; LO-PIPO, 87.0% [20 out of 23 participants]). Mortality in the EO-PIPO group was higher than in the LO-PIPO group (P = 0.002). Twenty-one patients died, of which 18 (85.7%) patients had EO-PIPO and 14 (66.7%) patients died under 1 year of age. Infection was the major cause of death. Severe malnutrition was observed at baseline and during follow-up in 25 (43.1%) and 6 (16.2%) patients, respectively. At baseline and during follow-up, the zinc deficiency rates were 29.6% and 26.3%, and those of vitamin D were 26.9% and 52.6%, respectively.CONCLUSIONS:Zinc and vitamin D deficiencies are common in patients with PIPO during follow-up. Therefore, additional supplements should be recommended.

A 15-year-old girl was admitted to our Pediatric Intensive Care Unit (PICU) due to respiratory failure and septic shock. She was intubated and mechanically ventilated and received vasoactive drugs therapy. Chest CT scan showed opacities in both lungs with marked consolidation in the right (figure 1A). Saline contrast-enhanced electrical impedance tomography (EIT) was conducted with 10 ml 5% NaCl bolus injection through the central venous catheter.1 Significant reductions in ventilation and perfusion were observed in the right dorsal regions (figure 2A). Shunt percentage was much higher in the dorsal regions. The patient received bedside bronchoalveolar lavage with fiberoptic bronchoscope therapy in PICU. The airway mucosa was congested, edematous and diffusely hemorrhagic. White mucus plugs were observed in the right airway, especially in the basal segment of the right lower lobe. The terminal bronchioles (generations 5-7) were completely blocked (figure 3A-B). A total of 100 ml sterilized isotonic saline was instilled in five aliquots and the lavage fluid and sputum were sucked out subsequently with 100 mmHg negative pressure after each insufflation (figure 3C-D). The bronchoalveolar lavage fluid next-generation sequencing test suggested that the pathogen was mycoplasma pneumoniae and the patient was treated with levofloxacin. After receiving bronchoscopy and bronchoalveolar lavage for three consecutive days, bedside EIT measurement suggested improvements of ventilation and perfusion in the right dorsal regions (figure 2B). Shunt percentage was significantly reduced. The findings were coincided with subsequent CT scans (figure 1B). The patient was successfully weaned from ventilator 1 day after last bronchoalveolar lavage. To our knowledge, this is the first clinical report to evaluate the efficacy of bronchoalveolar lavage on regional ventilation and perfusion at the bedside in severe mycoplasma pneumoniae pneumonia with lung consolidation. In severe mycoplasma pneumoniae pneumonia, about 24.9% patients were accompanied with lung consolidation. Fiberoptic bronchoscopy and bronchoalveolar lavage therapy can help detecting mycoplasma pneumoniae pneumonia pathogen in time, with detecting infection, locating sputum plug and inflammatory polyps, and improving consolidation. 22 However, a real-time bedside tool for evaluating the effectiveness of bronchoalveolar lavage in PICU was still missing. Saline-bolus based EIT evaluating the ventilation-perfusion matching has been implemented in adult lung diseases. 1,31,3 This case shows that EIT has the potential to identify regional ventilation and perfusion defects in the lesion areas, as well as to evaluate the corresponding improvement after bronchoalveolar lavage. No side effects were observed after the 10 ml 5% NaCl bolus injection. Further studies are warranted to confirm the clinical use of EIT in bronchoalveolar lavage in various pediatric age group and lung diseases This article is protected by copyright. All rights reserved.

There is some evidence that nighttime blood pressure varies between seasons. In the present analysis, we investigated the seasonal variation in ambulatory nighttime blood pressure and its associations with target organ damage. In 1054 untreated patients referred for ambulatory blood pressure monitoring, we performed measurements of urinary albumin-to-creatinine ratio (ACR, n = 1044), carotid-femoral pulse wave velocity (cfPWV, n = 1020) and left ventricular mass index (LVMI, n = 622). Patients referred in spring (n = 337, 32.0%), summer ( n = 210, 19.9%), autumn ( n = 196, 18.6%) and winter ( n = 311, 29.5%) had similar 24-h ambulatory systolic/diastolic blood pressure ( P ≥ 0.25). However, both before and after adjustment for confounding factors, nighttime systolic/diastolic blood pressure differed significantly between seasons ( P < 0.001), being highest in summer and lowest in winter (adjusted mean values 117.0/75.3 mm Hg vs . 111.4/71.1 mm Hg). After adjustment for confounding factors, nighttime systolic/diastolic blood pressure were significantly and positively associated with ACR, cfPWV and LVMI ( P < 0.006). In season-specific analyses, statistical significance was reached for all the associations of nighttime blood pressure with target organ damage in summer ( P ≤ 0.02), and for some of the associations in spring, autumn and winter. The association between nighttime systolic blood pressure and ACR was significantly stronger in patients examined in summer than those in winter (standardized β, 0.31 vs 0.11 mg/mmol, P for interaction = 0.03). In conclusion, there is indeed seasonality in nighttime blood pressure level, as well as in its association with renal injury in terms of urinary albumin excretion. Our study shows that there is indeed seasonal variability in nighttime blood pressure, highest in summer and lowest in winter, and its association with renal injury in terms of urinary albumin excretion varies between summer and winter as well.

Abstract Background In a cohort of hospitalized children with congenital heart disease (CHD), a new digital pediatric malnutrition screening tool as a mobile application was validated, and its effectiveness and clinical value were determined as a prospective study. Methods and results Children with CHD (n = 1125) were screened for malnutrition risk. The incidence of risk and the differences among various age groups and types of CHD were characterized. The optimal threshold for the tool to determine if there is a risk of malnutrition is score 2, while the Youden index was 79.1%, and the sensitivity and specificity were 91.2% and 87.9%, respectively. Based on such criterion, 351 children were at risk of malnutrition accounting for 31.20% of the total. Compared with the non-malnutritional risk group, the median age for the group at risk for malnutrition was younger (8.641 months [4.8, 23.1] vs. 31.589 months [12.4, 54.3], P < 0.01), and the length of stay was longer (12.000 [8.0, 17.0] vs. (8.420 [5.0, 12.0], P < 0.01]. There were significant differences in malnutrition risk among different age groups (χ2 = 144.933, P < 0.01), and children under one year of age exhibited the highest risk for malnutrition and more extended hospital stay (H = 78.085, P < 0.01). The risk of malnutrition among children with cyanotic CHD was higher than in those with non-cyanotic CHD (χ2 = 104.384, P < 0.01). Conclusions The new digital pediatric malnutrition screening tool showed high sensitivity and specificity in children with CHD. The tool indicated that the malnutrition risk for young children and children with cyanotic or Bethesda moderate and complex CHD was higher, and the hospitalization time was longer than in the non-risk group. The tool provides a rational approach to targeted nutrition intervention and support and may improve clinical outcomes.

Objective: Brachial blood pressure (BP) presents a circadian rhythm. Abnormal rhythms are associated with adverse outcomes. However, it is not clear about the circadian rhythm of central BP and its predictive value. Methods: The study participants were patients referred to the outpatient clinic of Ruijin Hospital for 24-hour ambulatory BP monitoring from the year 2017 to 2020. The 24-hour brachial and central ambulatory BP monitoring were performed with the use of the Mobil-O-Graph (Germany) monitors. Dipping, non-dipping, reverse dipping and extreme dipping were defined as a night-to-day systolic BP ratio of 0.8–0.9, 0.9–1.0, > 1.0, and < 0.8, respectively. In cross-classification analysis of brachial and central dipping status, extreme dipping and reverse dipping were grouped with dipping and non-dipping, respectively. The vital status of patients until Dec 2020 was ascertained according to the vital statistics of the Shanghai Center for Disease Prevention and Control. Results: In 26,023 enrolled patients (men 47.4%, average age 53.0 years) followed up for a median of 1.8 years, 120 deaths occurred. The prevalence of non-dipping (46.7% vs. 43.7%, respectively) and reverse dipping (16.0% vs. 13.1%) was significantly (P < 0.001) higher for central than for brachial BP. The hazard ratios (95% confidence intervals, [CI]) for all-cause mortality were statistically significant for reverse dipping (1.95 [1.18–3.23] and 2.37 [1.43–3.94], respectively), but not other dipping status, versus dipping in brachial and central BP, respectively. In the brachial and central cross-classification analysis, the prevalence of consistent dipping, consistent non-dipping, isolated central non-dipping, and isolated brachial non-dipping was 34.7%, 54.2%, 8.6%, and 2.5%, respectively. Taking the consistent dipping as reference, the hazard ratios (95% CI) for all-cause mortality were 1.83 (0.77–4.31), 1.34 (0.46–3.95), and 1.94 (1.20–3.15) for isolated central, isolated brachial and consistent non-dipping, respectively. Furthermore, cross-classification significantly improved the risk prediction of all-cause mortality with a net reclassification improvement index (95% CI) of 0.193 (0.069–0.304). Conclusions: Non-dipping and reverse dipping were more common for central than for brachial BP, and were associated with a higher mortality risk irrespective of brachial or central BP. Cross-classification of brachial and central dipping status further improved risk stratification.

Objective: Arterial stiffness, as a subclinical target organ damage, was an independent predictor of cardiovascular events. Parameters calculated from the 24-hour ambulatory blood pressure monitoring (ABPM), such as ambulatory arterial stiffness index (AASI), symmetrical AASI (sAASI), the 24-hour pulse pressure (PP) and its components expressed as elastic PP (elPP) and stiffening PP (stPP), can be used to indirectly assess arterial stiffness. Up to now, few studies have compared the associations of health outcomes with these parameters. Design and method: Out-patients who completed 24-hour ABPM (Mobil-O-Graph, Germany) at Ruijin Hospital (Shanghai, China) from 2017 to 2020 were recruited. All-cause and cardiovascular mortality (ICD10 codes I00-I99) was ascertained according to the death registry in Shanghai Municipal Center for Disease Control and Prevention. Standardized hazard ratios (HR) and 95% confidence intervals were computed with Cox regression models and adjusted for 24-hour mean arterial blood pressure and other confounders. Results: Among the 29,519 participants (mean age 52.9 years, 46.8% males) followed up for a median of 2.8 years, 244 participants died, and 78 died from cardiovascular events. In unadjusted analyses, all studied ambulatory arterial parameters were all associated with all-cause (HR, 1.41-1.87; P<0.001) and cardiovascular (HR, 1.55-2.17; P<0.001) mortality. After multivariable adjustment, AASI, the 24-hour PP, elPP and stPP remained significantly associated with all-cause (HR, 1.18-1.35; P<0.014) and cardiovascular (HR, 1.28-1.38; P<0.048) mortality, while the associations became non-significant for stPP in relation to cardiovascular death, and for sAASI with all-cause and cardiovascular outcomes. Conclusions: Arterial parameters derived from the 24-hour ABPM were independently associated with mortality outcomes, with some differences in the associations among different parameters.

Objective: To investigated the clinical efficacy of Soluble thrombomodulin (sTM), tissue plasminogen activator inhibitor complex (t-PAI center dot C),thrombin-antithrombin complex (TAT),alpha 2-plasmininhibitor-plasmin complex (PIC) in pediatric sepsis and pediatrics sepsis-induced coagulopathy (pSIC). Methods: We prospectively collected patient data with sepsis diagnosed in the PICU of Shanghai Children's Medical Center from June 2019 to June 2021. sTM,t-PAI center dot C, TAT,PIC and classical coagulation laboratory tests (CCTs) were evaluated on the day of sepsis diagnosis. Results Fifty-nine children were enrolled, There were significant differences in t-PAI center dot C (P = 0.001), Plt (P < 0.001), PT (P < 0.001), INR (P < 0.001), aPTT (P < 0.001), and TT (P = 0.048) between the pSIC and non-pSIC groups, logistic regression analysis showed that Plt (P = 0.032) was an independent risk factor for pSIC. Logistic regression analysis showed that sTM (P = 0.007) and Plt (P = 0.016) were independent risk factors for the outcome in pediatrics sepsis following discharge. The AUC of sTM combined with Plt on the mortality outcome of children with sepsis at discharge was 0.889 (95%CI: 0.781,0.956). which was better than that for PRISM III (AUC, 0.723), pSOFA (AUC, 0.764), and blood Lac (AUC, 0.717) when sepsis was diagnosed in the PICU. Conclusions The t-PAI center dot C increased in children with pSIC. The prediction of sepsis outcome using sTM combined with Plt was better than with PRISM III, pSOFA, or Lac.Further research is still needed in the future to explore the clinical value of sTM, TAT, PIC, and t-PAI center dot C in diagnosis and outcome of pediatrics sepsis and pSIC.