Mycoplasma pneumoniae pneumonia （MPP） is a common cause of community-acquired pneumonia in children aged 5 and older in China. Although most affected children have favorable clinical prognosis， some cases can escalate into severe MPP due to risk factors such as pathogen resistance or co-infections， etc. These severe cases significantly jeopardize the lives of children and may lead to diverse long-term sequelae. In response to this challenge， the Children’s Medical Center of the Third Affiliated Hospital of Sun Yat-sen University， integrating current guidelines， expert consensus， and its extensive clinical experience， has devised the “412” cluster treatment strategy. This comprehensive approach encompasses treatments for anti-infection， anti-inflammatory storm， anticoagulation and antioxidant stress. Additionally， it seamlessly integrates traditional Chinese medicine with western therapies， featuring bundled respiratory management and follow-up care. This strategy provides a valuable reference for the diagnosis and treatment of severe MPP in children.
Objective To systematically review the progress in the application of artificial intelligence in the field of pediatric otolaryngology-head and neck surgery at home and abroad， aiming to provide reference for the development and clinical practice in the future. Methods Literature related to the application of artificial intelligence in otolaryngology，head and neck surgery were searched from PubMed， Web of Science and Embase databases in June 2024， regardless of the research type， publication date and language restrictions. Subsequently， using the National Heart， Lung， and Blood Institute Study Quality Assessment Tools （NHI-SQAT） and the Oxford 2011 Levels of Evidence （LOE）， tables were designed to assess the quality of the articles and select authentic and effective literature. Literature content was extracted， and a systematic review of current status and future prospects of artificial intelligence in this field was conducted. Results After preliminary screening of abstracts and titles， full-text reading， supplementary retrieval， and exclusion of literature that did not meet quality standards， a total of 38 articles were finally included. Artificial intelligence has been widely used in the diagnosis and treatment of pediatric otolaryngological diseases in various forms. Significant clinical effects have been achieved through methods such as machine learning and big data processing， enabling surgical assistance and the establishment of diagnostic and treatment models. In recent research， the diagnosis and treatment of pediatric otitis media， assessment of pediatric hearing loss， preoperative planning and postoperative guidance， and telemedicine are becoming the main directions of exploration and application of artificial intelligence. Conclusions Application of artificial intelligence in pediatric otolaryngology head and neck surgery at home and abroad has been gradually extended in recent years. As the use of artificial intelligence in assisted diagnosis and treatment has been gradually accepted by the medical community， the application platform for artificial intelligence will become diversified in the future.
With the increasing maturity of neonatal intensive care technology， the survival rate of premature infants has been increased significantly. At the same time， the incidence of brain injury has also been elevated year by year， and most of the affected children are complicated with early clinical manifestations and long-term sequelae of nervous system injury. Therefore， finding a simple and effective diagnostic method to improve the quality of life of premature infants has become a key problem to be solved urgently in the current field. In recent years， more and more biological markers of brain injury have been studied and applied to the early diagnosis and prognosis assessment of brain injury in premature infants. This article reviews the domestic and international research progress on these biological markers， aiming to provide reference for the early diagnosis and prognosis assessment of brain injury in premature infants.
Objective To evaluate the predictive value for serum albumin-globulin ratio （A/G） for the risk of Kawasaki disease （KD） in febrile children. Methods In this single-center retrospective cohort study， the big-data platform of a certain third-tier A-level hospital was employed. Clinical and laboratory data of 432 febrile children aged 0-16 were collected. The children were divided into 4 groups based on the quartiles and median of their serum A/G ratios. The correlation between the A/G and the risk of KD was analyzed. Results The total incidence rate of KD in 432 children with fever was 14.4% （62/432）.A significant negative correlation was observed between the A/G and the risk of KD. For each increase of 0.1 in the A/G， the risk of KD was decreased by 18% （OR=0.82， 95% CI 0.76-0.88， P < 0.001）. Subgroup analysis showed a consistent negative correlation between the A/G and KD risk across different ages， genders， and biochemical markers. Conclusions A/G may be a useful biomarker for assessing the risk of KD in febrile children. As the A/G increases， the risk of KD is gradually decreased. This finding has potential clinical application value for early diagnosis and risk assessment of KD.
Objective To investigate the pathogenic role of neutrophil extracellular traps （NETs） in the pathogenesis and progression of severe Mycoplasma pneumoniae pneumonia （SMPP） in children and to assess their predictive value for SMPP. Methods Children with Mycoplasma pneumoniae pneumonia （MPP） admitted to the Second Hospital of Lanzhou University from October to December 2023 were selected as the study subjects. They were divided into the non-severe group （MPP group， n = 45） and severe group （SMPP group， n = 39）. The levels of NETs in the serum and bronchoalveolar lavage fluid （BALF） of all children were measured using ELISA. Additionally， BALF from both the affected and contralateral sides was collected from children in the SMPP group， and the content of NETs in BALF was determined using ELISA. Results A significant difference was observed in the serum concentration of NETs between MPP and SMPP patients （P < 0.01）. In the SMPP group， the level of NETs in the BALF of the affected lung was significantly higher than those of the contralateral side （P < 0.001）. Serum NETs levels were significantly higher than those in BALF in SMPP group （P < 0.001）. The area under the ROC curve （AUC） for predicting SMPP based on serum NETs levels was 0.892 （95%CI 0.810-0.963， P < 0.001）， with a sensitivity of 0.821 and specificity of 0.875， and a cut-off value of 17.24 ng/mL，respectively. The AUC of the combination of serum NETs with C-reactive protein （CRP） and lactate dehydrogenase （LDH） levels for predicting SMPP was 0.974 （95%CI 0.946-1.000， P < 0.001）， with a sensitivity of 0.923 and specificity of 0.950， respectively. Conclusions Excessive activation of NETs may contribute to the incidence of SMPP and localized lung injury in children with MPP. Monitoring the serum levels of NETs， CRP and LDH can effectively predict the incidence of SMPP. The combination of NETs， CRP， and LDH yields the best predictive performance.
Objective To evaluate the clinical application value of positional management guided by 12-zone lung ultrasound（LUS） in the treatment of neonatal infectious pneumonia. Methods A total of 76 neonates with a gestational age of >36 weeks and corrected gestational age of <44 weeks， clinically diagnosed with neonatal infectious pneumonia， were selected as the study subjects. They were randomly divided into the LUS-guided positional management group （treatment group） and conventional positional management group （control group）. Compare the changes in LUS （assessed by LUS 12-zone score） before the intervention and on the 3rd and 7th days after the intervention， as well as the duration of oxygen therapy and hospital stay， between the two groups of children. Results Prior to intervention， the LUS scores in both groups were significantly higher than those of the anterior and lateral chest （all P < 0.05）. On 7th day after the intervention， the LUS scores of dorsal in the treatment group were significantly lower than those in the control group （P < 0.05）， and in both groups， the LUS scores of dorsal remained significantly higher than those of the anterior and lateral chest （all P < 0.001）. Additionally， the LUS scores of chest were significantly higher than those of the anterior chest （P < 0.001）. The total LUS score on 7th day after the intervention in the treatment group were significantly lower than that in the control group（P < 0.05）， and compared to pre-intervention and the 3rd day after the intervention， the total LUS score in the treatment group showed a significant decrease （both P < 0.001）. The length of hospital stay in the treatment group was significantly shorter than that in the control group （P < 0.05）. Conclusion Positional management guided by 12-zone LUS is beneficial in promoting the recovery from neonatal infectious pneumonia and shortening the length of hospital stay.
Objective To observe the systemic reactions （SRs） associated with subcutaneous immunotherapy （SCIT） using dust mite allergen and to analyze potential risk factors. Methods The occurrence of SRs among 230 patients with allergic rhinitis （AR） who received house dust mite SCIT from December 2019 to December 2022 was retrospectively analyzed， and related risk factors were identified. Results A total of 5 422 injections were given to 230 patients， with an SRs incidence rate of 2.4% per injection and 20.0% per patient. Most SRs were grade I （51.9%）， and no fatal SRs occurred. Symptoms primarily affected the respiratory system for 111 times （84.7%）. Elevated peripheral blood eosinophil count （OR （95% CI）=6.02 （1.76， 20.60）， P = 0.004） and high levels of house dust mite-specific IgE （OR （95% CI）=1.01 （1.00， 1.01）， P = 0.016） were identified as risk factors for SRs， respectively. Conclusions Children with AR allergic to dust mites may experience SRs during SCIT with standardized dust mite allergen preparations， whereas the overall safety of SCIT is good. High eosinophil count and high levels of house dust mite-specific IgE are risk factors for SRs during SCIT.
Objective To investigate the changes of angiotensin-converting enzyme （ACE） and angiotensin-converting enzyme 2 （ACE2） levels in children with severe Mycoplasma pneumoniae pneumonia （SMPP） and evaluates their clinical values in predicting the severity of SMPP. Methods A total of 71 children with Mycoplasma pneumoniae pneumonia （MPP group） and 63 with severe Mycoplasma pneumoniae pneumonia （SMPP group） admitted to the Second Hospital of Lanzhou University from October 2020 to December 2023 were recruited in this study. Additionally， 20 healthy children undergoing routine health check-ups during this period were selected as the control group. The serum concentrations of ACE and ACE2 in the three groups were measured using the enzyme-linked immunosorbent assay （ELISA）， and laboratory test results were collected for comparison and correlation analysis between the MPP and SMPP groups. The receiver operating characteristic （ROC） curve was delineated to assess the predictive values of one single index or combined for SMPP. Results In the three groups， the serum ACE level was the highest in the SMPP group and the lowest in the healthy control group. The serum ACE2 level was the highest in the MPP group and the lowest in the healthy control group （all P < 0.008）. Compared to the MPP group， the SMPP group exhibited significantly elevated white blood cell count （WBC）， neutrophil percentage （NE%）， C-reactive protein （CRP）， serum amyloid A protein （SAA）， procalcitonin （PCT）， interleukin-6 （IL-6）， erythrocyte sedimentation rate （ESR）， and D-dimer （all P < 0.001） and these indexes were positively correlated with ACE levels （all P < 0.05）， but negatively correlated with ACE2 levels （all P < 0.05）. The lymphocyte percentage （LY%） was significantly reduced （P < 0.001）， which was positively correlated with ACE2 levels （P < 0.05）， whereas negatively correlated with ACE levels （P < 0.05）. Lactate dehydrogenase （LDH） was elevated （P < 0.05）， which was negatively correlated with ACE2 levels （P < 0.05）， but not correlated with ACE levels （P > 0.05）. The monocyte percentage （MO%） showed neither significant difference nor correlation （both P > 0.05）. ROC curve analysis revealed that ACE， ACE2， CRP， D-dimer， LDH， and combined detection of ACE+ACE2， CRP+D-dimer+LDH all had predictive values for SMPP. Among them， the combined detection of ACE+ACE2 showed the highest predictive value， with an AUC of 0.991 and 95% CI： 0.981-1.000. Conclusion The levels of ACE and ACE2 are likely associated with the onset and progression of SMPP in children， and both ACE and ACE2 serve as good indicators for predicting SMPP.
Objective To construct prediction models for moderate/severe bronchopulmonary dysplasia （BPD） in extremely preterm infants at different days after birth. Methods The preterm infants with BPD at a gestational age of < 28 weeks at the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to December 2019 were retrospectively selected. They were divided into the mild-BPD group and moderate/severe-BPD group. The significant variables screened by using single-factor analysis were subject to risk assessment analysis by multivariate Logistic regression analysis. Early prediction models were established， and the predictive performance was validated and evaluated. Results Ninety extremely preterm infants were included in this study， including 58 cases （64.4%） in the mild-BPD group and 32 cases （35.6%） in the moderate/severe-BPD group. Multiple Logistic regression analysis showed birth weight， maternal pre-pregnancy body mass index （BMI） ≥ 25 kg/m2， 1-minute Apgar score≤7 after birth and pneumonia were the influencing factors for moderate/severe BPD at 7 days after birth. Preeclampsia， maternal pre-pregnancy BMI≥25 kg/m2， pneumonia and hsPDA were the risk factors for moderate/severe BPD at 14 days postnatal age. Preeclampsia， maternal pre-pregnancy BMI≥25 kg/m2， days of invasive mechanical ventilation and hsPDA were the risk factors for moderate/severe BPD at 28 days after birth. The area under the receiver operating characteristic （ROC） curve of the prediction models for 7， 14 and 28 days after birth were 0.864 （95% CI 0.776-0.952）， 0.860 （95% CI 0.774-0.946） and 0.863 （95% CI 0.783-0.944）， respectively. A nomogram was constructed based on high risk factors， the calibrated curve was close to the reference line， and the predicted value was close to the actual value， indicating good calibration of the model. Conclusions The risk factors for moderate/severe BPD in preterm infants vary slightly on 7， 14 and 28 days after birth， mainly the birth weight， maternal pre-pregnancy BMI ≥ 25 kg/m2， 1-minute Apgar score≤7， pneumonia， preeclampsia， hsPDA and days of invasive mechanical ventilation. The predictive models based on different factors at different time points have good predictive value， which can provide guidance for clinical practice.
Objective To explore the clinical characteristics of acute attacks of bronchial asthma （BA） in children in Kashgar region， and analyze the impact of 25-hydroxyvitamin D3 （25（OH）D3） levels on disease severity. Methods Children with acute BA attacks， aged 6-14 years， admitted to a certain thirdtier A-level Hospital of Kashgar were enrolled and divided into different groups according to disease severity （mild， moderate and severe） and 25（OH）D3 levels （normal， insufficiency and deficiency）. Clinical characteristics were compared among different groups. The correlation between 25（OH）D3 levels and disease severity was analyzed. Results A total of 112 children were enrolled， with a male-to-female ratio of 2.61∶1， with a median age of 9.0 （7.0-11.0） years old. The highest incidence was found in spring （42.9%）. The positive rate of allergens is 74.1%（83/112）， with inhaled allergens as the main type （89.1%）， and the tree combination had the highest positive rate （47.0%）.Based on disease severity， 36 cases were assigned into the mild group， 51 cases in the moderate group， and 25 cases in the severe group. As the disease severity was aggravated， the forced vital capacity （FVC）， forced expiratory volume at 1 second （FEV1）， and the ratio of FEV1 to FVC（FEV1/FVC） were gradually decreased （all P <0.001）. The eosinophil （EOS） count in the severe group was higher than that in the mild group （P < 0.05）. According to 25（OH）D3levels， 28 cases had normal 25（OH）D3 levels， 21 cases with insufficient 25（OH）D3 levels， and 35 cases with 25（OH）D3 deficiency. The FVC， FEV1， FEV1/FVC， and peak expiratory flow （PEF） in the 25（OH）D3 deficiency group were significantly lower than those in the insufficient and normal 25（OH）D3 groups （all P < 0.05）. The disease severity significantly differed among three groups （H = 9.538， P = 0.008）. Serum 25 （OH） D3 levels were negatively correlated with the severity of BA attacks （τ = -0.304， P =0.002）. Conclusions Spring is the peak season of acute attacks of BA in school-age children from Kashgar. Inhaled allergens are mainly composed of tree combination. As the severity of this condition deteriorates， lung function of the affected children are gradually declined. Serum 25 （OH） D3 levels are associated with lung function and the severity of acute attacks in children with BA.
Objective To investigate the related influence factors of neonatal transfusion-associated necrotizing enterocolitis （TANEC）. Methods Clinical data of neonates with necrotizing enterocolitis （NEC） treated by surgery were retrospectively analyzed. All participants were divided into the TANEC and non-TANEC groups. Clinical characteristics， maternal conditions， laboratory test results， intraoperative conditions and clinical prognosis were subject to univariate and multivariate Logistic regression analyses. Related factors of TANEC were identified. The predictive values of these factors were determined by the receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC）. Results A total of 51 infants were enrolled in this study， including 13 cases in the TANEC group and 38 in the non-TANEC group. Univariate analysis showed statistically significant differences in birth weight， Apgar-1 score， gestational age， number of transfusions， patent ductus arteriosus and hemoglobin level between two groups （all P < 0.05）. Multivariate Logistic regression analysis revealed that the number of transfusions and hemoglobin level were the related factors for the incidence of TANEC （both P < 0.05）. ROC curve verified that the AUC of the number of transfusions was 0.882 （95% CI 0.794-0.969）， 0.857 （95% CI 0.747-0.968） for hemoglobin level， and 0.907 （95% CI 0.822-0.992） for the two combined， respectively. Conclusion The number of blood transfusion and hemoglobin level are associated with the occurrence of TANEC， and the combination of these two can better predict the incidence of TANEC.
Objective To understand the distribution of allergens in different altitude areas of Yunnan Province and evaluate the impact of meteorological factors on the sensitization rate of allergens， providing a theoretical basis for formulating reasonable allergen screening programs in different regions of Yunnan Province. Methods A retrospective analysis was conducted in children with allergic rhinitis （AR） admitted to Department of Otolaryngology of Kunming Children’s Hospital from January 2022 to December 2023， and their permanent places of residence were Xishuangbanna prefecture， Dehong prefecture， Honghe prefecture， Zhaotong， Kunming， Dali prefecture， and Diqing prefecture. Skin prick tests （SPT） were performed， and the positive results of SPT and demographic data were analyzed. At the same time， the relationship between altitudes and meteorological factors and allergens was analyzed by considering the altitudes of these seven regions and meteorological data （average temperature， average annual relative humidity， average annual wind speed， and average annual precipitation） during the same period. Results A total of 8， 175 data sets were collected. Under different meteorological and altitude conditions， the positive rate of SPT for dust mites and partial pollen allergens showed significant differences （all P < 0.05）， and dust mites remained the main allergen even at high altitudes. The positive rate of dust mite SPT was positively correlated with the average annual temperature and negatively correlated with the altitude （both P <0.05）； the positive rate of pollen SPT was negatively correlated with the average annual relative humidity （P < 0.05）； the positive rate of dust mite SPT was increased with age （P < 0.05）. Conclusion The distribution of allergens in different meteorological and altitude areas of Yunnan Province may vary， and personalized diagnosis， treatment， prevention programs need to be formulated.
