To refine a method of assessing lumbar stability by applying artificial intelligence and incorporating the use of a walking aid during imaging procedures. A software application was developed to evaluate lumbar stability parameters using machine learning and neural network models (Swin-Resnet). The intra-class correlation coefficient (ICC) was used to assess the agreement between Swin-Resnet and the evaluations conducted by three spine surgeons, each with over ten years of experience. Subsequently, traditional flexion-extension radiographs (FET) and flexion-extension radiographs with a walking aid (FEW) were performed on the enrolled patients with lumbar spondylolisthesis. The developed software was used to measure parameters such as sagittal translation, segmental angulation, and detection rate of lumbar instability. There was no significant statistical difference in the average error between the Swin-Resnet model and physicians in terms of sagittal translation, segmental angulation, and agreement of lumbar instability assessment. The average values of sagittal translation and segmental angulation were significantly higher in FEW than in FET (2.40 (1.09, 3.59) vs. 0.56 (0.16, 1.40); 8.00 (5.00, 10.25) vs. 2.00 (1.00, 5.25), P < 0.05). Among 50 patients, FEW detected 19 cases (38

ObjectiveTo develop and internally validate an explainable machine learning model for early mortality prediction in pediatric sepsis using routinely available clinical variables, to support clinical risk stratification and decision-making.MethodsA total of 752 children with sepsis admitted to the Pediatric Intensive Care Unit (PICU) at the Children's Hospital of Soochow University between January 1, 2019, and June 30, 2023, were retrospectively enrolled. Twenty-six routinely available clinical variables obtained within 24 h after PICU admission were included. After data preprocessing, variables with excessive missing values, significant multicollinearity, or limited univariate predictive value were excluded. Clinically meaningful ratio-derived variables were constructed, and logarithmic transformation was applied to selected right-skewed continuous variables. Twelve supervised machine learning algorithms were developed and compared for mortality prediction. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), precision–recall (PR) curve, decision curve analysis (DCA), and other performance metrics. Model interpretability was assessed using SHapley Additive exPlanations (SHAP).ResultsAmong the 12 machine learning algorithms, extreme gradient boosting (XGBoost) achieved the best overall predictive performance. Following recursive feature elimination based on permutation importance, a simplified XGBoost model incorporating seven variables was established and interpreted using SHAP. In the internal validation cohort, the final model achieved an AUC of 0.803, with a sensitivity of 0.846, specificity of 0.696, accuracy of 0.722, and an F1 score of 0.512. The mean AUCs obtained from 5-fold and 10-fold cross-validation were 0.780 ± 0.044 and 0.771 ± 0.070, respectively, indicating good model stability. SHAP analysis identified pH, PaO₂, glucose, blood urea nitrogen (BUN), lactate dehydrogenase (LDH), international normalized ratio (INR), and the BUN-to-creatinine ratio (BUN/Cr) as the features that made the greatest contributions to the final model's mortality predictions.ConclusionAn explainable XGBoost-based prediction model was developed for early mortality prediction in pediatric sepsis using seven routinely available clinical variables collected within 24 h after PICU admission. The model demonstrated good discrimination, stability, and model-based interpretability, suggesting its potential as a practical tool for early risk stratification and individualized clinical management. Further multicenter external validation is warranted before routine clinical implementation.

Background Osteoporotic vertebral compression fractures (OVCFs) of the lumbar region may be accompanied by thoracic fractures. Treating only the lumbar fractures can lead to worsening of the thoracic fractures or unresolved postoperative symptoms. This study aims to investigate the need to perform thoracic MRI before vertebral augmentation (including percutaneous vertebroplasty and percutaneous kyphoplasty) in patients with lumbar OVCF.Methods This study retrospectively analyzed patients with lumbar OVCF who were scheduled for surgical treatment. All patients underwent thoracic and lumbar MRI before surgery. We evaluated the proportion of thoracic fractures accompanying lumbar fractures at each segment and identified the common locations of these accompanying fractures. Univariate and multivariate analyses were conducted to determine the risk factors and optimal thresholds for predicting accompanying thoracic fractures.Results The study recruited 700 patients, of whom 96 (13.71%) had new thoracic fractures along with lumbar fractures. The most common thoracic segments affected were T10 (22.50%), T9 (19.17%), T8 (26.67%), and T7 (20.83%). Univariate analysis showed significant differences in age and cause of injury between the thoracic fracture group and the control group. The bone density of the thoracic fracture group was significantly lower than that of the control group. Multivariate logistic regression analysis indicated that lifting heavy objects, sprains, and low bone density are risk factors for thoracic fractures in patients with lumbar OVCF.Conclusion It is crucial to perform thoracic MRI before surgery in patients with lumbar OVCF. This helps to avoid missing thoracic fractures, prevent the worsening of injuries, and ensure better postoperative outcomes.

Objective The objective of this study is to examine the risk factors associated with apnea in hospitalized patients diagnosed with bronchiolitis and to develop a nomogram prediction model for the early identification of patients who are at risk of developing apnea.Methods The clinical data of patients diagnosed with acute bronchiolitis and hospitalized at the Children's Hospital of Nanjing Medical University between February 2018 and May 2021 were retrospectively analyzed. LASSO regression and logistic regression analysis were used to determine the risk factors for apnea in these patients. A nomogram was constructed based on variables selected through multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve and calibration curve were used to assess the accuracy and discriminative ability of the nomogram model, and decision curve analysis (DCA) was performed to evaluate the model's performance and clinical effectiveness.Results A retrospective analysis was conducted on 613 children hospitalized with bronchiolitis, among whom 53 (8.6%) experienced apnea. The results of Lasso regression and Logistic regression analyses showed that underlying diseases, feeding difficulties, tachypnea, WBC count, and lung consolidation were independent risk factors for apnea. A nomogram prediction model was constructed based on the five predictors mentioned above. After internal validation, the nomogram model demonstrated an AUC of 0.969 (95% CI 0.951-0.987), indicating strong predictive performance for apnea in bronchiolitis. Calibration curve analysis confirmed that the nomogram prediction model had good calibration, and the clinical decision curve analysis (DCA) indicated that the nomogram was clinically useful in estimating the net benefit to patients.Conclusion In this study, a nomogram model was developed to predict the risk of apnea in hospitalized children with bronchiolitis. The model showed good predictive performance and clinical applicability, allowing for timely identification and intensified monitoring and treatment of high-risk patients to improve overall clinical prognosis.

Background: K & uuml;mmell disease (KD)-a rare and relatively complex spinal condition-is a type of posttraumatic osteoporotic vertebral compression fracture manifesting as a delayed collapse of a vertebral body. Although most patients with KD present with pain in the fracture area, some present with pain in the rib region or distal lumbosacral region, without pain in the fracture area, which poses challenges for diagnosing and treating KD. Objective: We aimed to explore whether percutaneous kyphoplasty can alleviate pain distal to the fracture area caused by either Stage I or Stage II KD. Study Design: A retrospective study. Setting: This study was conducted at a university-affiliated hospital. Methods: We conducted a retrospective analysis on patients with Stage I or Stage II KD who underwent surgical treatment in our hospital from December 2021 through October 2023. All patients were accompanied by pain distal to the fracture area (i.e., pain in the rib region or the distal lumbosacral region). All patients underwent percutaneous kyphoplasty. Postoperative follow-up thoracic or lumbar x-rays confirmed polymethylmethacrylate diffusion and vertebral reduction. Pain distal to the fracture area and functional impairment were evaluated at presurgery and at postsurgery one day, one week, and one month. In addition, the anterior, middle, and posterior vertebral heights and the Cobb angle were measured at pre- and postsurgery. Results: A total of 42 patients were enrolled; 39 (92.9%) were women. Their average age was 73.48 +/- 8.81 years. The fracture segments with KD and pain distal to the fracture area were as follows: T7 (9 cases, 21.4%); T10 (9 cases, 21.4%); and T8 (8 cases, 19.0%). The common location of pain distal to the fracture area was the rib region (30 cases, 71.4%). The preoperative Visual Analog Scale score of pain distal to the fracture area and the Oswestry Disability Index scores were significantly higher than those at postsurgery one day, one week, and one month. The heights of the anterior, middle, and posterior edges of the vertebrae on x-ray were significantly higher postoperatively than preoperatively. The Cobb angle of the fractured vertebrae was also higher postoperatively than preoperatively. Limitations: Our study was conducted at a single center; single-center studies may introduce bias. Our study also had a relatively short follow-up time. Conclusion: Patients with Stage I or Stage II KD may experience pain distal to the fracture area, which may effectively be alleviated by percutaneous kyphoplasty

Abstract Purpose: To explore the clinical efficacy of minimally invasive percutaneous internal fixation "three point & two step" procedure for type II Galeazzi fracture without severing pronator quadratus. Methods: Patients admitted to the orthopedic department between December 2018 and February 2022 owing to type II Galeazzi fracture were eligible for analysis.All participants underwent "three point - two step", minimally invasive percutaneous, plate internal fixation, and were assessed for the surgical duration, intraoperative blood loss, postoperative fracture healing, and functional recovery of the affected limb. Results: The follow-up duration was 20.5 ± 10.7 months; the distal incision was 27.5 ± 2.5 mm and the proximal incision was 35 ± 3.78 mm; overall 38.21 ± 30.27 ml of intraoperative blood loss occurred among the analyzed patients; otherwise, all patients showed good alignment of the lower ulnar and radial joints, with no fracture nonunion. The patients received DASH and Mayo scores of 6.37 ± 1.24 and 88.21 ± 8.99, respectively, at 6 months post operation, and exhibited an excellent rate of 85.7%. Conclusions: The minimally invasive percutaneous internal "three point & two step" fixation for type II Galeazzi fracture has the advantages of minimal trauma, rapid recovery, and maximal regaining of wrist function. Thus, this procedure should be clinically promoted.

BACKGROUND Osteoporotic vertebral compression fractures (OVCF) are common. A few patients with thoracic vertebral fracture show pain in the bilateral rib region but not at the fracture site. The point of specific tenderness in the rib region cannot be located. It is not clear whether percutaneous kyphoplasty (PKP) can relieve the pain in the bilateral rib region in these patients. OBJECTIVE To check whether PKP can alleviate the rib region pain in thoracic vertebral fracture patients without local pain at the fractured vertebra. STUDY DESIGN Retrospective study. SETTING The study was carried out at a university hospital. METHODS We performed a retrospective analysis of thoracic vertebral fracture patients admitted to our hospital for PKP surgery between January 2018 and June 2022. The main clinical manifestations of these patients were pain in the bilateral rib region but no local tenderness and percussion pain at the fractured vertebra. CT and MRI examinations of the thoracic vertebrae were performed after admission. PKP was performed under general anesthesia after no surgical contraindication. Visual analog scale (VAS) scores and heights of the anterior, middle, and posterior edges of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. Also, the Cobb angles formed by the upper and lower endplate of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. RESULTS A total of 50 patients were included in this study (3 men and 47 women, with an average age of 72.46 ± 8.15 years), of which 7 patients had 2 segmental fractures, so a total of 57 vertebrae were included. The VAS scores on day one and one month after the surgery were significantly lower than that before the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra on day one after the surgery were significantly higher than those before the surgery. The Cobb angle of the fractured vertebra on day one after the surgery was lower than that before the surgery. The vertebrae of 23 patients were examined using x-ray one month after the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra one month after the surgery were also significantly higher than those before the surgery but significantly lower than those one day after the surgery. Also, the Cobb angle of the fractured vertebra one month after the surgery was significantly lower than that before the surgery. LIMITATIONS This was a retrospective study, which may be prone to selection and recall bias. Single-center non-controlled studies may also introduce bias. CONCLUSION The exact location of the pain in the rib region caused by thoracic fracture cannot be identified usually. PKP can alleviate the rib region pain caused by the thoracic fracture.

巨细胞病毒（CMV）肺部感染是儿童潜在的致命疾病，然而CMV肺部感染的诊断面临着巨大的挑战。潜伏性CMV感染与活动性CMV感染之间的区分很困难，这将导致支气管肺泡灌洗CMV聚合酶链式反应检测出现假阳性。宿主危险因素和肺部感染特征的综合评估对于诊断儿童CMV肺部感染至关重要。最重要的宿主危险因素是免疫抑制状态，包括原发性和继发性免疫缺陷病，新生儿尤其是早产儿等。肺部感染特征方面，活动性CMV肺部感染的典型特征是肺泡炎性反应引起的低氧血症、影像学磨玻璃样改变和肺活检发现CMV包涵体肺泡内浸润。了解目前儿童CMV肺部感染的诊断方法和进展可提高临床医生对CMV肺部感染的诊治能力。

IntroductionImmunity is involved in a variety of bone metabolic processes, especially osteoporosis. The aim of this study is to explore new bone immune-related markers by bioinformatics method and evaluate their ability to predict osteoporosis. MethodsThe mRNA expression profiles were obtained from GSE7158 in Gene expression Omnibus (GEO), and immune-related genes were obtained from ImmPort database (https://www.immport.org/shared/). immune genes related to bone mineral density(BMD) were screened out for differential analysis. protein-protein interaction (PPIs) networks were used to analyze the interrelationships between different immune-related genes (DIRGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of DIRGs function were performed. A least absolute shrinkage and selection operation (LASSO) regression model and multiple Support Vector Machine-Recursive Feature Elimination (mSVM-RFE) model were constructed to identify the candidate genes for osteoporosis prediction The receiver operator characteristic (ROC) curves were used to validate the performances of predictive models and candidate genes in GEO database (GSE7158,GSE13850).Through the RT - qPCR verify the key genes differentially expressed in peripheral blood mononuclear cells Finally, we constructed a nomogram model for predicting osteoporosis based on five immune-related genes. CIBERSORT algorithm was used to calculate the relative proportion of 22 immune cells. ResultsA total of 1158 DEGs and 66 DIRGs were identified between high-BMD and low-BMD women. These DIRGs were mainly enriched in cytokine-mediated signaling pathway, positive regulation of response to external stimulus and the cellular components of genes are mostly localized to external side of plasma membrane. And the KEGG enrichment analysis were mainly involved in Cytokine-cytokine receptor interaction, PI3K-Akt signaling pathway, Neuroactive ligand-receptor interaction,Natural killer cell mediated cytotoxicity. Then five key genes (CCR5, IAPP, IFNA4, IGHV3-73 and PTGER1) were identified and used as features to construct a predictive prognostic model for osteoporosis using the GSE7158 dataset. ConclusionImmunity plays an important role in the development of osteoporosis.CCR5, IAPP, IFNA4, IGHV3-73 and PTGER1were play an important role in the occurrences and diagnosis of OP.

Objective We aimed to develop a nomogram to predict the risk of severe influenza in previously healthy children. Methods In this retrospective cohort study, we reviewed the clinical data of 1135 previously healthy children infected with influenza who were hospitalized in the Children's Hospital of Soochow University between 1 January 2017 and 30 June 2021. Children were randomly assigned in a 7:3 ratio to a training or validation cohort. In the training cohort, univariate and multivariate logistic regression analyses were used to identify risk factors, and a nomogram was established. The validation cohort was used to evaluate the predictive ability of the model. Result Wheezing rales, neutrophils, procalcitonin > 0.25 ng/mL, Mycoplasma pneumoniae infection, fever, and albumin were selected as predictors. The areas under the curve were 0.725 (95% CI: 0.686–0.765) and 0.721 (95% CI: 0.659–0.784) for the training and validation cohorts, respectively. The calibration curve showed that the nomogram was well calibrated. Conclusion The nomogram may predict the risk of severe influenza in previously healthy children.

Objective:To explore the clinical charecteristics, imaging features, therapy and prognosis of stroke in children, and provide help for clinical treatment.Methods:The clinical data of 49 children with stroke were collectedand retrospectively analyzed in the Children′s Hospital of Soochow University from January 1, 2019 to December 31, 2019.Results:A mong the 49 children with stroke, 35 were male and 14 were female, aged 1-178 (65.69 ± 55.22) months; the specific etiologies were cerebrovascular malformation, craniocerebral trauma, tumor, vitamin K deficiencies, infectious diseases, rheumatic immune diseases, hemophilia and congenital heart disease. The first symptoms of stroke were disturbance of consciousness, hemiplegia, convulsions, vomiting and headache. The arterial ischemic stroke (18 cases) were mainly caused by craniocerebral trauma and cerebrovascular malformation. The hemorrhagic stroke (31 cases) were mainly caused by arteriovenous malformation, vitamin K deficiency and tumor. The surgical rate in the arterial stroke group was significantly lower than that in the hemorrhagic stroke group.Conclusions:Traumatic cerebral infarction and intracranial arteriovenous malformation are the main causes of arterial ischemic stroke and hemorrhagic stroke in children. Early diagnosis and treatment can significantly improve prognosis.

Background: Percutaneous kyphoplasty (PKP) is widely used in osteoporotic vertebral compression fractures (OVCF). But in some patients, distal lumbosacral pain (DLP) persists even after treatment and affects their quality of life. Objective: To investigate the effectiveness of local anesthetic and steroid injection in improving DLP after PKP. Study Design: A prospective, randomized, and controlled clinical trial. Setting: The study was carried out in a university hospital. Methods: A total of 150 patients were included in this study and randomly divided into 2 groups of 75 patients each. Patients in the control group (PKP) underwent PKP, and those in the observation group (PKP + LAI) received an injection of lidocaine + triamcinolone acetonide suspensions during the surgery. The visual analog scale (VAS) of the fracture site, Oswestry disability index (ODI), and the rate of patients with lower back pain were compared between the 2 groups at 1 day, 3 days, 1 week, 1 month, and 3 months after the surgery. Results: One hundred thirty-nine patients completed the entire postoperative follow-up schedule, with 70 patients in the PKP group and 69 cases in the PKP + LAI group. The VAS and ODI in the PKP + LAI group were significantly lower than those in the PKP group 1 day, 3 days, 1 week, and 1 month after the surgery; there was no significant difference 3 months after the operation. The rate of patients with lower back pain in the PKP + LAI group 1 day, 3 days, and 1 week after the operation was significantly lower than that in the control group; there was no significant difference 1 month and 3 months after the operation. Limitations: The number of cases was small, and the follow-up time was short. Conclusion: Local anesthetic and steroid injection improved the short-term clinical outcome of PKP for OVCF, which will enhance the confidence of patients in performing out-of-bed activities and functional exercises early after the operation.

Clinical data of a child with acquired immunodeficiency syndrome characterized by ischemic stroke who was admitted to the Pediatric Intensive Care Unit of Children′s Hospital Affiliated to Soochow University in January 2019 were retrospectively analyzed.The child is a 6 years and 4 months old boy with a history of thrombocytopenic purpura and recurrent respiratory infections.The main complaint was " the right limb weakness for more than 10 days" . The head magnetic resonance imaging (MRI) revealed extensive abnormal signals in the bilateral frontal and parietal lobes and the formation of softening foci in the left thalamus and outer capsule.Blood routine showed white blood cell 4.88×10 9/L, lymphocyte ratio 0.291, lymphocyte count 1.42×10 9/L, hemoglobin 99 g/L, and platelet 23×10 9/L.Lymphocyte subsets included CD3 + 84.1%, CD3 + CD4 + 0.2%, CD3 + CD8 + 61.4%, CD4 + /CD8 + 0, CD3 -CD 19+ 9.2%, CD3 -CD 16+ 56+ 6.1%, and CD 19+ CD 23+ 5.8%.Pretransfusion tests suggested human immunodeficiency virus (HIV) (+ ), and that other results were negative.Both parents of the child were infected with HIV.This paper demonstrates that neurological involvement is not rare in HIV infection, and stroke is the most common cause of clinical focal neurological deficits in HIV-infected children.Screening with MRI is recommended for high-risk children with neurologic symptoms or neurocognitive dysfunction.

Objective To determine the risk factors for delayed radiographic resolution in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and explore the most suitable time for interventional bronchoscopy. Methods This retrospective study involved 142 children with RMPP who were admitted to our hospital from 1 January 2015 to 31 December 2017. They were divided into a common resolution group and a delayed resolution group based on their chest radiograph series. Results Among the 142 patients, 67 showed common resolution on chest radiographs and 75 showed delayed resolution. Independent risk factors for delayed resolution were a clinical course of ≥11.5 days before the performance of interventional bronchoscopy, mucus plug formation, corticosteroid resistance, and atelectasis. When bronchoscopy was performed before the disease had been present for <11.5 days, the length of hospitalization, total fever duration, and duration of time until disappearance of coughing were shorter than those in children who underwent bronchoscopy after the disease had been present for ≥11.5 days. Conclusions Corticosteroid resistance, the time to interventional bronchoscopy, atelectasis, and mucus plug formation were associated with delayed resolution on chest radiographs. Performance of interventional bronchoscopy before the clinical course has reached 11.5 days may help alleviate clinical symptoms and improve radiographic resolution. Keywords Refractory , pneumonia , bronchoscopy , children , chest radiograph , delayed resolution , clinical course

Objective To determine the risk factors for delayed radiographic resolution in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and explore the most suitable time for interventional bronchoscopy. Methods This retrospective study involved 142 children with RMPP who were admitted to our hospital from 1 January 2015 to 31 December 2017. They were divided into a common resolution group and a delayed resolution group based on their chest radiograph series. Results Among the 142 patients, 67 showed common resolution on chest radiographs and 75 showed delayed resolution. Independent risk factors for delayed resolution were a clinical course of ≥11.5 days before the performance of interventional bronchoscopy, mucus plug formation, corticosteroid resistance, and atelectasis. When bronchoscopy was performed before the disease had been present for <11.5 days, the length of hospitalization, total fever duration, and duration of time until disappearance of coughing were shorter than those in children who underwent bronchoscopy after the disease had been present for ≥11.5 days. Conclusions Corticosteroid resistance, the time to interventional bronchoscopy, atelectasis, and mucus plug formation were associated with delayed resolution on chest radiographs. Performance of interventional bronchoscopy before the clinical course has reached 11.5 days may help alleviate clinical symptoms and improve radiographic resolution.

Objective:To explore the role of Mycoplasma pneumoniae (MP) in hospitalized children with community-acquired pneumonia (CAP) in Suzhou.Methods:Pathogen data of 2 367 patients with bronchiolitis, bronchopneumonia, lobar pneumonia, and interstitial pneumonia were retrospectively analyzed from January 2017 to December 2018 in Children′s Hospital of Soochow University. The detected pathogens were MP, respiratory syncytial virus (RSV), adenovirus (Adv), influenza A, B, parainfluenza virus (PIV) 1, 2 and 3, human metapneumovirus (hMPV), boca virus (HBoV) and bacteria.Results:The most common pathogen of bronchiolitis was RSV (34.9%, 249/713), followed by MP (15.8%, 113/713) and hMPV (11.4%, 85/713). The most common pathogen of bronchial pneumonia was Streptococcus pneumoniae (Sp, 14.8%, 180/1 220), followed by RSV (13.1%, 160/1 220) and MP (10.2%, 124/1 220). The most common pathogen of lobar pneumonia was MP (47.8%, 141/295), followed by Sp(12.9%, 38/295). The most common pathogen of interstitial pneumonia was MP (35.3%, 49/139), followed by RSV (23.0%, 32/139) and Adv (6.5%, 9/139). Compared with non-MP infections, children with MP infections were older, and had higher percentage of fever and less shortness of breath. The adjusted OR(95% CI) was 2.4 (1.1-3.5), 5.1 (3.2-10.4) and 0.2 (0.0-0.4), respectively. Conclusions:MP is the most common pathogen of lobar pneumonia and interstitial pneumonia and the second most common cause of bronchiolitis. MP infections are usually associated with older age, higher percentage of fever and less shortness of breath.

Background. Several efforts have been made to find out a valuable marker to assist the diagnosis and differentiation of gangrenous/perforated appendicitis. We aimed to determine the diagnostic capacity of soluble B7H3 (sB7H3) in acute appendicitis (AA) and its accuracy as a predictor of the severity of appendicitis. Methods. 182 children were allocated into four groups as follows: control group (CG, 90), simple appendicitis (SA, 12), purulent appendicitis (PA, 49), and gangrenous appendicitis (GA, 31). Prior to appendectomy, blood was collected and sent for analysis of routine examination and cytokines (sB7H3 and TNF-α). We compared values of all measured parameters according to histological findings. Furthermore, we assigned AA patients into the nonperforated appendicitis group and the perforated appendicitis group. The diagnostic effects of significant markers were assessed by ROC curves. Results. Only the levels of CRP, FIB, and sB7H3 had a remarkable rising trend in AA-based groups, while differences in the levels of CRP and FIB between simple appendicitis and purulent appendicitis were not statistically significant. In addition, sB7H3 was found as the only marker in children with AA, which was markedly associated with the degree of histological findings of the appendix. Furthermore, sB7H3 had a high diagnostic value in predicting AA and complex appendicitis (PA+GA) in children. However, the diagnostic performance of sB7H3 for distinguishing PA from GA was not remarkable. Additionally, only the levels of CRP and sB7H3 were statistically different between the nonperforated appendicitis group and the perforated appendicitis group. The diagnostic performance of CRP and sB7H3 could not merely predict perforation of AA in children; however, the diagnostic performance was improved after combination. Conclusions. sB7H3 could be used as a valuable marker to predict the presence of AA and complex AA in children. However, the diagnostic value of sB7H3 to predict gangrenous/perforated appendicitis was not found to be remarkable. The combination of sB7H3 and CRP might improve the prediction of perforated appendicitis.

Background This study aimed to describe the causative organisms of neonatal late-onset sepsis (LOS) and their antimicrobial resistance in Suzhou, Southeast China over a 7-year period. Methods We performed a retrospective study on neonates with LOS from Jan1, 2011 to Dec 31, 2017. The demographic, clinical, and laboratory data of neonates with LOS were analyzed. Logistic regression was used to investigate the risk factors with mortality. Results During the study period, 202 neonates with LOS were finally identified. The most common pathogens wereEscherichia coli(29.2%), followed byKlebsiella pneumoniae(19.3%), and Coagulase-negative Staphylococcus (CoNS) (16.8%). Nearly 90% of theK. pneumoniaewere resistant to cefazolin and 71.8% to ceftazidime. Thirty-four patients (16.8%) died. Multivariable logistic regression showed that significant predictors of mortality were birth weight < 1500 g, respiratory distress and convulsions. Conclusions Gram-negative organisms have an important role in LOS in our region, with high levels of resistance to third-generation cephalosporins. These data may help in the selection of antibiotics for empirical treatment of neonates with sepsis.

Transient receptor potential melastatin 2 (TRPM2) is an important ion channel that represents a potential target for treating injury caused by cerebral ischemia. However, it is unclear whether reducing TRPM2 expression can help repair cerebral injury, and if so what the mechanism underlying this process involves. This study investigated the protective effect of reducing TRPM2 expression on pheochromocytoma (PC12) cells injured by oxygen-glucose deprivation (OGD). PC12 cells were transfected with plasmid encoding TRPM2 shRNAS, then subjected to OGD by incubation in glucose-free medium under hypoxic conditions for 8 hours, after which the cells were allowed to reoxygenate for 24 hours. Apoptotic cells, mitochondrial membrane potentials, reactive oxygen species levels, and cellular calcium levels were detected using flow cytometry. The relative expression of C-X-C motif chemokine ligand 2 (CXCL2), NACHT, LRR, and PYD domain–containing protein 3 (NALP3), and caspase-1 were detected using fluorescence-based quantitative reverse transcription-polymerase chain reaction and western blotting. The rates of apoptosis, mitochondrial membrane potentials, reactive oxygen species levels, and cellular calcium levels in the TRPM2-shRNA + OGD group were lower than those observed in the OGD group. Taken together, these results suggest that TRPM2 knockdown reduces OGD-induced neuronal injury, potentially by inhibiting apoptosis and reducing oxidative stress levels, mitochondrial membrane potentials, intracellular calcium concentrations, and NLRP3 inflammasome activation.

SOAP教学法是我国儿童重症医学科住院医师规范化培训的一种探索,它能够改善临床医疗文件的书写现状和提高临床推理能力,但对临床实践操作技能改善不大,提示重症医学科规培医师的临床操作能力提高还需要通过其他教学方法来实现.