Yunlian Zhou

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.

Mixed infection with influenza A virus (IAV) and Staphylococcus aureus (S. aureus) is a serious concern in children. S. aureus, particularly Panton-Valenti

Auscultatory analysis using an electronic stethoscope has attracted increasing attention in the clinical diagnosis of respiratory diseases. Recently, neural networks have been applied to assist in respiratory sound classification with achievements. However, it remains challenging due to the scarcity of abnormal respiratory sound. In this paper, we propose a novel architecture, namely Waveform-Logmel audio neural networks (WLANN), which uses both waveform and log-mel spectrogram as the input features and uses Bidirectional Gated Recurrent Units (Bi-GRU) to context model the fused features. Experimental results of our WLANN applied to SPRSound respiratory dataset show that the proposed framework can effectively distinguish pathological respiratory sound classes, outperforming the previous studies, with 90.3% in sensitivity and 93.6% in total score. Our study demonstrates the high effectiveness of the WLANN in the diagnosis of respiratory diseases.

Purpose: To explore the clinical characteristics, treatment, and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in children. Patients and Methods: The medical records of 16 children who were diagnosed with MPP associated with PE between January 2016 and January 2023 at Children’s Hospital, Zhejiang University School of Medicine were retrospectively reviewed. Results: The average age patients were 8.24 ± 1.99 years. All cases were diagnosed with refractory mycoplasma pneumoniae pneumonia (RMPP) and presented complications in the form of necrotizing pneumonia (NP). The main symptoms observed were cough and fever (n = 16, 100%), chest pain (n = 8, 50%), dyspnea (n = 8, 50%), and hemoptysis (n = 4, 25%). In these cases, 12 patients had involvement of the pulmonary artery, 3 patients experienced issues with the pulmonary vein, and 1 patient had simultaneous involvement of both the pulmonary artery and pulmonary vein. Among the 12 pulmonary artery embolism cases, 6 involved the right pulmonary artery, 4 involved the left pulmonary artery, and 2 involved both the right and left pulmonary arteries. The mean D-dimer level was 8.50 ± 4.76 mg/L. All patients received anticoagulant therapy, and after treatment, there was a significant improvement in their symptoms and lung lesions. Conclusion: Children with RMPP, chest pain, hemoptysis, and elevated D-dimer levels should be closely monitored for the potential development of PE. The co-occurrence of MPP and PE often involves the presence of NP. In cases of confirmed PE, anticoagulation therapy may be a suitable consideration. PE and NP resulting from MPP generally had a favorable overall prognosis.

Background: This study aimed to explore the clinical characteristics and management of mycoplasma pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in children and gain a better understanding of the diagnosis treatment and prognosis of the disease. Methods: We retrospectively reviewed the medical records of 16 children who were diag-nosed with MPP associated with PE and NP between Janunary 2016 and Janunary 2023 at Children’s Hospital, Zhejiang University School of Medicine. Results: All of the cases were diagnosed with refractory mycoplasma pneumoniae pneum-onia (RMPP) and complicated with necrotizing pneumonia(NP). The ages of the patients ranged from 5.3 to 11.5 years old. The main manifestations were cough and fever（n=16, 100%）,chest pain (n=8, 50%) , shortness of breath(n=8,50%), hemoptysis (n=4, 25%). Among them, the pulmonary artery was involved in 12 patients, including 6 cases on the right, 4 cases on the left, and 2 cases on both sides. Besides, the pulmonary vein was suffered in 3 patients. Furthermore, Pulmonary artery and pulmonary vein were involved in 1 patient. The mean D-dimer level was 8.50±4.76mg/L. All patients underwent anticoa-gulant therapy. After treatment, all patients ’s symptoms were improved, and the lung lesions were significantly improved. Conclusion: For children with RMPP, PE and NP should be considered when chest pain, hemoptysis or high level of d-dimer are present. Chest enhanced CT scan should be perf-ormed as soon as possible, and anticoagulation should be treated once the diagnosis of PEis confirmed. The long-term prognosis of PE was favorable after the timely administrationof anticoagulant therapy.

Necrotizing pneumonia (NP) is an uncommon complicated pneumonia with an increasing incidence. Early recognition and timely management can bring excellent outcomes. The diagnosis of NP depends on chest computed tomography, which has radiation damage and may miss the optimal treatment time. The present review aimed to elaborate on the reported predictors for NP. The possible pathogenesis of Streptococcus pneumoniae, Staphylococcus aureus, Mycoplasma pneumoniae and coinfection, clinical manifestations and management were also discussed. Although there is still a long way for these predictors to be used in clinical, it is necessary to investigate early predictors for NP in children.