Lanfang Tang

Background/Objectives: Human metapneumovirus (hMPV) is a leading cause of acute respiratory tract infections in children, but comorbidities and mixed infections have confounded most previous studies. This study aimed to develop an early prediction model for severe respiratory illness in children with isolated hMPV infection. Methods: This retrospective study enrolled 540 children with isolated hMPV infection (without comorbidities or mixed infections) hospitalised between February 2022 and January 2024. Severe respiratory illness was defined according to British Thoracic Society guidelines. Multivariable logistic regression analysis was performed to identify predictors and develop a nomogram, with model performance evaluated by AUC, Hosmer–Lemeshow test, and bootstrap validation. Results: Six independent predictors were identified: male sex (protective factor, OR = 0.500), elevated neutrophil count (OR = 1.114), decreased lymphocyte count (OR = 0.829), decreased prealbumin level (OR = 0.992), crackles (OR = 1.858), and wheezes (OR = 3.734). The nomogram achieved an AUC of 0.743 (95% CI: 0.690–0.796) and demonstrated good calibration performance (Hosmer–Lemeshow p = 0.139, Brier score = 0.136). Risk stratification classified patients into low-risk (30%) groups, with severe illness rates of 5.1%, 16.7%, and 46.0%, respectively (p < 0.001). Conclusions: The nomogram incorporating six early-admission indicators may serve as a practical tool for early risk stratification in hospitalised children with isolated hMPV infection.

Introduction: Managing recurrent congenital tracheoesophageal fistula (rTEF) is clinically challenging. Repeat thoracotomy is technically demanding due to dense adhesions and carries high morbidity, whereas outcomes of conventional endoscopic interventions vary, and sustained closure may be difficult to achieve in complex recurrent fistulas. We report the use of bronchoscopy-guided intratracheal suturing in a refractory case. Case Presentation: A 17-year-old male with a history of congenital TEF experienced multiple recurrences despite two thoracotomies and one endoscopic clipping attempt. The procedure was performed under general anesthesia without endotracheal intubation, and superimposed high-frequency jet ventilation was used for airway management. Following electrocautery treatment of the visible tracheal-side margins, four interrupted absorbable sutures were placed through tissues adjacent to the fistula opening under bronchoscopic guidance. Tightening of the sutures approximated the visible fistula margins. The procedure lasted 62 min with no complications. Follow-up bronchoscopy, methylene blue testing, and esophagography at 2 weeks showed no evidence of fistula leakage, indicating early technical closure. At the 3-month telephone follow-up, the patient remained asymptomatic and reported normal oral intake and physical activity. These findings suggest early technical success; longer objective follow-up is required to assess durability. Conclusions: In this highly selected adolescent, bronchoscopy-guided intratracheal suturing was technically feasible and achieved early fistula closure without a perioperative complication. Longer objective follow-up after loss of suture tensile strength is required to determine whether closure can be maintained without mechanical suture support.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic technique. While widely used in adults, its application for diagnosing mediastinal masses in pediatric patients remains underreported. This gap poses challenges when addressing atypical presentations, such as pulmonary cryptococcosis in immunocompetent children, which is frequently misdiagnosed due to nonspecific symptoms. We present the case of a healthy nine-year-old male with an eight-day history of fever and cough. Computed tomography revealed a mediastinal mass in the left hilum and a mass in the left lower lobe. Following unsuccessful empirical antibiotic therapy, further invasive investigation was warranted. This article describes an EBUS-TBNA protocol tailored for pediatric patients. The procedure was performed using total intravenous anesthesia and a laryngeal mask airway. An ultrasound bronchoscope was advanced, and Doppler imaging was used to confirm the target lymph node's relationship with the surrounding vasculature. In this case, a lesion under the second carina was identified. A 22 G aspiration needle was inserted to a depth of 1-2 cm. Maintaining 5-15 mL of negative pressure, 20-30 rapid agitations were performed to obtain samples. The biopsy samples underwent histopathological examination and next-generation sequencing. The tissue demonstrated positive periodic acid-Schiff and Grocott methenamine silver staining, supporting identification of Cryptococcus spp. Following targeted fluconazole therapy, the patient achieved complete clinical and radiographic recovery. This case illustrates the potential usefulness of EBUS-TBNA in a carefully selected pediatric patient when conventional tests fail.

Primary pulmonary tumors in pediatric patients are rare; however, they are frequently malignant, posing significant diagnostic challenges. Therefore, the present study aimed to systematically investigate the clinical, imaging and pathological characteristics of primary pulmonary tumors in children. A total of 36 pediatric patients diagnosed with primary pulmonary tumors were included. Clinical data were collected, including clinical manifestations, imaging findings, pathological analysis, diagnosis and therapy. Among 36 pediatric patients with primary pulmonary tumors, 19 were girls and 17 were boys. The age at diagnosis was 2.0-9.8 years with a median of 4 years. A total of 11 histopathologic tumor types were identified, with pleuropulmonary blastoma (PPB) being the most prevalent. The clinical manifestations were nonspecific, primarily presenting as respiratory symptoms, including cough and fever. These symptoms were frequently associated with complications, including pleural effusion and atelectasis. The maximum tumor diameter ranged from 2.0 to 7.0 cm (median: 4.0 cm), with a predominance of unilateral and unifocal lesions. Furthermore, younger age at diagnosis, solitary lesions and larger non-cystic tumors are indicative of a higher likelihood of PPB. The surgical treatment of thirty-five patients was primarily comprised of open thoracotomy and thoracoscopic surgery. Chemotherapy was administered to 16 patients, while two received a combination of chemotherapy and radiotherapy. Follow-up data were available for 33 patients, with a median follow-up time of 15.0 months and three patients experienced tumor recurrence. The clinical manifestations of primary pulmonary tumors in children are not specific. Imaging and pathological characteristics are valuable in the differential diagnosis of benign and malignant tumors. Younger age at diagnosis, solitary lesions and larger non-cystic tumors are indicative of a higher likelihood of PPB. Integrating molecular diagnostics is an important direction for future research to improve early detection and treatment outcomes.

Human coronavirus NL63 (hCoV-NL63) is a major pathogen associated with pediatric acute respiratory tract infections. Although most infections are mild, severe lower airway complications have been increasingly reported. The aim of this study was to investigate the clinical and flexible bronchoscopy (FB) findings, as well as the interventional value, in young infants with hCoV-NL63-associated necrotizing laryngotracheobronchitis (NLTB). A retrospective case series was conducted at a tertiary pediatric intensive care unit between August 2025 and September 2025. Clinical data, including demographics, symptoms, imaging, FB findings, etiological test results, treatment strategies, and clinical outcomes of 3 young infants with confirmed hCoV‑NL63‑related NLTB were systematically analyzed. All patients presented with progressive hoarseness, dyspnea, stridor, and upper airway obstruction as primary manifestations. FB demonstrated characteristic subglottic mucosal necrosis, ulceration, and airway stenosis in all cases. Urgent FB‑guided endotracheal intubation was successfully performed to secure the airway. Bronchoalveolar lavage fluid (BALF) examination confirmed hCoV‑NL63 infection, with concurrent Streptococcus pneumoniae detected in all samples. After comprehensive treatment including systemic glucocorticoids, broad‑spectrum antibiotics, airway management, and supportive care, all young infants showed significant clinical improvement, survived without serious complications, and were discharged successfully. hCoV-NL63 may be associated with severe NLTB in young infants. FB may play a valuable and important role in early diagnosis, airway evaluation, and guided intubation. Multimodal therapy achieves favorable short‑term outcomes. Clinicians should strengthen awareness of this rare but severe entity to avoid delayed diagnosis and inappropriate intervention. This study is hypothesis-generating only, and larger studies are needed to confirm these results. Not applicable.

Background: The distinct roles of respiratory syncytial virus (RSV) and human rhinovirus (HRV) in acute illness and subsequent asthma remain debated. China's strict nonpharmaceutical interventions (NPIs) in 2022 provided a unique epidemiological setting to compare their clinical/inflammatory profiles and associations with long-term asthma risk. Methods: This observational retrospective cohort study included children hospitalized with RSV- or HRV-induced acute lower respiratory tract infections. We collected clinical data, subtyped RSV samples and conducted long-term follow-up to assess physician-diagnosed asthma using Kaplan–Meier and multivariable logistic regression. Results: Among 722 children (425 RSV, 275 HRV, and 22 coinfection), RSV predominated in infants with a sharp winter peak (RSV-A dominant, 96.8%), while HRV circulated year-round across a broader age range. RSV infection was associated with greater acute severity, including higher rates of pneumonia and longer hospitalization (P < .05). In contrast, HRV triggered a distinct inflammatory response with significant leukocytosis and an eosinophil count over 4-fold greater than the RSV group (P < .001). Follow-up revealed HRV infection was independently associated with increased risk of subsequent asthma (log-rank P < .001). Multivariable regression identified prior wheezing (aOR 2.82, 95% CI: 1.76–4.53), elevated eosinophils (aOR 2.43, 95% CI: 1.07–5.49), and HRV infection (aOR 1.85, 95% CI: 1.15–2.99) as independent predictors for asthma. Conclusions: During China's late NPI phase, HRV infection showed a stronger independent association with childhood asthma than RSV. This association, together with an eosinophil-predominant inflammatory profile, remained significant after adjustment for prior wheezing history. These findings should be interpreted as associations rather than evidence of causality.