Zhengxiu Luo

Bloodstream infection (BSI) remains a major global health problem associated with substantial morbidity and mortality [1]. The reported short-term mortality of BSI ranged from 10% to 30% [2], and t...

Objective: This study aims to screen indicators for predicting the occurrence of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children, determine the combined factors for predicting RMPP, and provide a basis for the early identification of children with RMPP and the determination of treatment plans. Methods: This study was a retrospective case–control analysis. A total of 522 children with MPP and 28 clinical indicators were included. Clinical feature, hospitalization period, laboratory data, etc., were collected. The risk factors related to RMPP were screened through univariate analysis. A multivariate logistic regression model was established, and stepwise regression was used to screen out independent risk factors. The operating characteristic curve (ROC) of the combined predictor was drawn for predictive efficacy analysis. A visual nomogram model for predicting the probability of RMPP occurrence was constructed and validated. Results: Differing from other results, there were no statistically significant differences in demographic indicators such as age and gender between the two groups. The multivariate logistic regression analysis showed that duration of fever (OR = 1.407), PLT (OR = 0.997), pleural effusion (OR = 2.084), atelectasis (OR = 3.116), and extrapulmonary complications (OR = 4.251) were independent risk factors for RMPP (P < 0.05). MP antibody titer ≥1:320 (OR = 0.420) is a protective factor. The AUC of the prediction model was 0.870 (95%CI: 0.837, 0.904), the sensitivity of the prediction model was 82.2%, the specificity was 80.5%, and the prediction accuracy was relatively high. The calibration curve, close to the 45° line, exhibited good calibration. Conclusion: We constructed and validated a visual and user-friendly model for individualized prediction of RMPP risk in children at initial presentation, to support clinical decision-making regarding macrolide therapy. This model provides a tool for identification of high-risk children, which may inform closer monitoring and prompt consideration of adjunctive therapies.

Background: Childhood pneumonia remains a leading driver of global mortality, yet its diagnosis in primary care is plagued by the absence of consistent, universally applied diagnostic criteria across facilities. This systematic review evaluates the diagnostic performance of clinical features for childhood pneumonia in primary care, stratified by country income level and age. Methods: We searched MEDLINE, Embase, Web of Science, CNKI, and Wanfang Data from inception to December 31, 2025. Prospective cohort studies assessing clinical features' diagnostic accuracy against chest radiography were included. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Random-effects meta-analyses were performed to pool sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC). The study was registered with PROSPERO (CRD420251179854). Findings: Fifty studies (n=48,138) met inclusion criteria, with 22 conducted in low- and middle-income countries (LMICs) and 27 in high-income countries (HICs). In LMICs, WHO age-specific tachypnea exhibited a weak association with pneumonia (PLR 2.00, 95% CI 1.10–3.70); however, fixed respiratory rate thresholds demonstrated stronger associations [PLR 2.5 (95% CI 1.6–4.0) for >40 breaths/min, 2.4 (95% CI 1.5–3.8) for >50 breaths/min, and 2.2–28.22 for >60 breaths/min], as did chest indrawing (PLR 2.5, 95% CI 1.3–4.9). In HICs, oxygen saturation ≤94% was the strongest predictor (PLR 3.31, 95% CI 2.45–4.47). The WHO pneumonia criteria demonstrated suboptimal performance (AUC 0.62, 95% CI 0.57–0.66). Multivariable models incorporating biomarkers improved discrimination (AUC 0.79–0.83) but frequently lacked external validation. Interpretation: The diagnostic accuracy of individual clinical features for childhood pneumonia is limited overall. Context-specific indicators (e.g., elevated respiratory rates and chest indrawing in LMICs, hypoxemia in HICs) and externally validated multivariable prediction tools are warranted to refine diagnostic guidelines and mitigate antibiotic overuse.

Background: Subglottic cysts (SGCs) are a rare disease with a high misdiagnosis rate. Objectives: We aim to improve the diagnostic and management ability of pediatricians for SGCs by analyzing the clinical characteristics of confirmed cases. Design: Observational, retrospective cohort study Methods: We enrolled children diagnosed with SGCs admitted to the Children’s Hospital of Chongqing Medical University between January 2010 and December 2022. Clinical characteristics data were collected and analyzed retrospectively. Patients were regularly followed up for 1 year post-treatment or discharge. Results: Eleven children were included in this retrospective study. There were nine (9/11, 81.8%) males and two (2/11, 18.2%) females, and the median age was 15 months. Eight (72.7%) were premature. Seven (63.6%) patients had a history of intubation. The common manifestations were stridor (72.7%), wet cough (72.7%), shortness of breath (72.7%), and dyspnea (54.5%). The average diagnosis time was 7 months. The most common comorbidity was laryngopharyngeal reflux disease (LPRD, 45.5%), followed by laryngomalacia (27.3%), bronchopulmonary dysplasia (27.3%), bronchial stenosis (18.2%), and adenoid hypertrophy ( 18.2%). The obstruction degree of SGCs was “3” (51%–75% occlusion) or higher in eight (72.7%) patients. Two (18.2%) patients experienced recurrence after initial cyst aspiration and subsequently underwent successful laryngoscopy marsupialization. Ultimately, eight (72.7%) patients achieved complete recovery after endoscopic marsupialization. Conclusion: SGCs should be considered in the differential diagnosis of children, especially those with a history of prematurity and/or perinatal intubation, who present with stridor, wet cough, and respiratory distress. Endoscopic evaluation is crucial for both definitive diagnosis and guiding effective treatment.

Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterised by progressive accumulation of surfactant-derived lipoproteinaceous material within alveoli, impairing gas exchange and causing respiratory insufficiency. Despite therapeutic advances such as whole lung lavage, substantial heterogeneity persists in outcome selection and reporting across studies, limiting comparability and evidence synthesis. Objective: To systematically map and categorise outcomes and outcome measures reported in studies of PAP treatments and establish a foundation for developing a standardised core outcome set (COS). Methods: A scoping review was conducted across four databases and two clinical trial registries (May 2024, updated May 2025). Eligible studies included those reporting treatment outcomes in patients of any age with PAP. Outcomes and measures were extracted and categorised using the Core Outcome Measures in Effectiveness Trials taxonomy. Results: From 8475 screened records, 62 studies met the inclusion criteria, encompassing 31 distinct outcomes and 92 corresponding outcome measures. Physiological parameters dominated reporting, including arterial oxygenation (n=55, 89%; such as arterial oxygen tension and alveolar–arterial oxygen gradient) and lung function indices (n=53, 85%; such as diffusing capacity of the lung for carbon monoxide and forced vital capacity) were most frequently assessed. In contrast, patient-centred outcomes such as quality of life were reported in only 10 (16%) studies, while adverse events were relatively well-reported (n=41, 66%). Conclusions: The reporting of outcomes and outcome measures in PAP studies is highly variable. There is an urgent need for a COS tailored to PAP that focuses on physiological outcomes, adverse events and patient-reported outcomes.

Background: While diabetes is a recognized risk factor for asthma, the shared genetic components between diabetes/glycemic traits and asthma remain unclear. This study investigates the genetic associations, causal relationships, and underlying mechanisms linking these conditions. Methods: We assessed global genetic correlations using linkage disequilibrium score regression (LDSC), high-definition likelihood analysis (HDL), and genetic covariance analysis (GNOVA). Trait pairs with significant correlations subsequently underwent genetic overlap analysis (Genetic analysis integrating Pleiotropy and functional Annotation, GPA) and local genetic correlation analysis (Local Genetic Variant Association Analysis, LAVA). Cross-phenotype association (CPASSOC) and multitrait analysis of GWAS (MTAG) identified potential pleiotropic loci, followed by colocalization and functional annotation. Proteome-wide association study (PWAS) revealed proteins and pathways shared between diabetes/glycemic traits and asthma. Generalized summary-data-based Mendelian randomization (GSMR) was used to evaluate causal effects between diabetes/glycemic traits and asthma. Results: Significant genetic correlations were observed between body mass index (BMI) and asthma (rg = 0.280–0.397; FDR < 0.05), type 2 diabetes mellitus (T2DM) and asthma (rg = 0.240–0.289; FDR < 0.05) across all three methods. GPA revealed significant genome-wide genetic overlap, highest for BMI and asthma (pleiotropy association ratio [PAR] = 0.377) and T2DM-asthma (PAR = 0.353). LAVA identified 111 significant local correlation regions, predominantly between T2DM and asthma (70 regions). Colocalization analysis identified 24 shared pleiotropic loci, predominantly on chromosome 8. Local genetic correlation analysis revealed extensive correlations between T2DM and asthma. PWAS identified 46 shared proteins, with IL6R, MAPK3, and CSF2 being key hubs. Protein–protein interaction analysis highlighted enrichment in JAK-STAT signaling, Th1/Th2 differentiation, and IL-17 pathways. GSMR demonstrated causal effects of BMI (OR = 1.47, 95% CI: 1.42–1.53, FDR < 0.05) and T2DM (OR = 1.06, 95% CI: 1.04–1.08, FDR < 0.05) on increased asthma risk, with no evidence of reverse causality. Conclusions: Obesity (BMI) and T2DM exert causal effects on asthma risk via shared genetic loci and inflammatory pathways, particularly involving IL6R, MAPK3, CSF2, and JAK-STAT signaling. Targeting these colocalized proteins may offer potential therapeutic strategies.

Background: Pediatric sepsis, a life-threatening condition, often progresses to septic shock. However, microbiological and clinical profiles between pediatric sepsis patients with and without septic shock remain underexplored. Methods: This retrospective cohort study included 1200 pediatric sepsis patients (Phoenix Sepsis Score ≥ 2) from the Children’s Hospital of Chongqing Medical University between June 2018 and June 2023. Pediatric sepsis patients with septic shock were diagnosed based on the Phoenix Cardiovascular Score being ≥1. Clinical data and pathogens were taken from the electronic medical records and analyzed. Univariate and multivariable logistic regressions were conducted to identify the risk factors for septic shock. Results: Septic shock patients had longer hospital stays (14.8 vs. 12.0 days, p = 0.003) and higher mortality (17.4% vs. 4.7%, p < 0.001) when compared to non-septic-shock patients. Among these two groups, the pathogen prevalence revealed that bacterial pathogens dominated (48.9%), followed by viruses (10.3%). Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus remained the predominant pathogens; Pseudomonas aeruginosa and Mycoplasma pneumoniae were also increased. Combination antibiotic therapy was most frequent in patients with viral and fungal sepsis (79% and 86.5%, respectively). Patients with fungal sepsis had significantly longer hospital stays than those with viral sepsis (20.74 vs. 12.97 days, p = 0.017). Multivariable analysis identified that elevated lactate (OR = 1.49, 95% CI = 1.29–1.75) and pulmonary infection (OR = 2.25, 95% CI = 1.35–3.73) were independent risk factors for septic shock. Conclusions: Children with septic shock had higher mortality and prolonged hospitalization, with distinct microbiological profiles when compared with patients in the non-septic-shock group. Elevated lactate and presence of pulmonary infection are independent risk factors for septic shock. Early recognition of high-risk patients and tailored antimicrobial strategies are critical for improving outcomes.

Sepsis remains a leading global health challenge, with delayed recognition and limited diagnostic accuracy of current tools contributing to high morbidity and mortality. Conventional clinical scores (SOFA/qSOFA), standard biomarkers (CRP, PCT), and blood cultures suffer from delayed responsiveness, insufficient specificity, or slow turnaround, underscoring the urgent need for more reliable early diagnostic strategies. Presepsin, a soluble CD14 subtype generated during pathogen recognition by innate immune cells, has emerged as a promising biomarker with potential to reflect infection status earlier and more specifically than traditional markers. This systematic review and meta-analysis quantitatively evaluated the diagnostic accuracy of presepsin across diverse populations. PubMed, EMBASE, Web of Science, and Cochrane Library were searched for studies published between 2015 and 2025. Forty-seven studies involving 7,087 participants were included. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), area under the curve (AUC), and likelihood ratios (PLR/NLR) with 95% confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed with I² statistics, meta-regression, and subgroup analyses. Study quality was evaluated using QUADAS-2. Presepsin demonstrated excellent overall diagnostic performance: pooled sensitivity 0.84 (95% CI: 0.81–0.88), specificity 0.86 (95% CI: 0.80–0.90), DOR 32.23 (95% CI: 20.11–51.66), and AUC 0.91 (95% CI: 0.88–0.93). Subgroup analyses confirmed robust performance across settings and populations, with particularly high accuracy in neonates (sensitivity 0.90, specificity 0.92, AUC 0.96), followed by children (sensitivity 0.84, specificity 0.81, AUC 0.88, NLR 0.20) and adults (sensitivity 0.81, specificity 0.82, AUC 0.87). Meta-regression identified year of publication, geographic region, specimen type, population, and diagnostic criteria as key contributors to heterogeneity, but sensitivity analyses confirmed result stability. No significant publication bias was observed (p = 0.33). In conclusion, presepsin is a valuable and highly promising biomarker for sepsis diagnosis, showing favorable diagnostic accuracy across populations, with strongest utility in neonates. Its application in pediatric and adult patients warrants further validation through large, prospective, multi-center studies.