Hypoxic-ischemic encephalopathy（HIE）is a condition in newborns caused by insufficient cerebral perfusion due to prenatal or intrapartum hypoxia and asphyxia，resulting in brain injury and a series of neurological symptoms in clinical practice.HIE affects the quality of life of newborns and endangers their health，can lead to neonatal mortality，and is one of the main causes of long-term sequelae.HIE is related to multiple factors，and hypoxia is the main cause of HIE in newborns.Amplitude-integrated electroencephalography （aEEG）and head MRI examination are important diagnostic tools for HIE.The degree of HIE can be referred to the modified Sarnat standard.Mild hypothermia therapy is the main treatment method currently recognized for HIE，and some drug therapy and rare gas therapy may become new attempts for treating HIE in newborns.In this paper，the author intends to present the latest research findings on the etiology，diagnosis，degree classification，and treatment of HIE in newborns.

Objective

To analyze the predictive value of endocervical curettage（ECC）for postoperative pathological upgrading to cervical cancer in patients with biopsy result of cervical intraepithelial neoplasia grade 2 or more severe diagnoses （CIN2+）.

Methods

A total of 66 pathological upgrading patients and 66 no-upgrading patients who attended the Department of Gynecology of West China Second University Hospital，Sichuan University from January 1，2019 to October 1，2023 were selected into this study，and were enrolled into study group and control troup，respectively.A retrospective analysis of the following data was done for the two group.①General clinical data：including age，gravidity，parity，menopausal status，abnormal vaginal bleeding，history of cervical lesions，transformation zone.②Clinical examination and pathological data：including cytology，human papilloma virus（HPV）test，pathological results （including cervical biopsy and ECC results），whether the lesion involved gland or not，and tumor characteristics of patients with pathologic upgrading to cervical cancer in the 2 groups of patients.The Kappa test was used to compare the results of cervical biopsy and ECC.Receiver operater curve（ROC）curve and area under curve（AUC）were plotted to calculate the predictive value of ECC for pathologic upgrading to cervical cancer.The procedures followed in this study complied with the ethical standards set by the Ethics Committee of West China Second University Hospital，Sichuan University（No.2024-474）and met the conditions for exemption of informed consent in clinical research.

Results

①The comparison of age，menopausal rate，cervical cytology results，the proportion of patients with a history of cervical precancerous lesions，and ECC pathological results between the two groups showed statistically significant differences （P＜0.05）.②Among the 66 patients in study group，the largest proportion was International Federation of Gynecology and Obstetrics （FIGO）stageⅠ，at 93.9%（62/66）.③The results of multivariate unconditional logistic regression analysis of the risk factors for CIN2+histological progression were presented as follow.Age （OR=1.111，95% CI：1.029-1.200，P=0.007）and ECC pathological result of CIN3（OR=8.587，95% CI：2.710-27.207，P＜0.001）were independent risk factors for pathological upgrading to cervical cancer post-surgery.④The number of patients with the same results between ECC and cervical biopsy was 59.The result of Kappa consistency test showed that the results of cervical biopsy were in poor agreement with the results of ECC （Kappa=0.101，P=0.062）.⑤ROC curve analysis showed that the AUC value of ECC for prediction of CIN2+histological progression was 0.761（95% CI：0.678-0.845），with a cut-off value of 2.5 and a positive predictive value of 75.4%.

Conclusions

ECC has a good predictive value for postoperative pathological upgrading to cervical cancer in patients with colposcopic pathological biopsy results of CIN2+，and should be used as a supplement to cervical biopsy in patients with suspected high-grade lesions.

Objective

To investigate the clinical characteristics and treatment strategies of renal abscesses in children.

Methods

A total of 5 cases of pediatric renal abscess children（child 1-5）admitted to the Department of Pediatrics，General Hospital of Ningxia Medical University from January 2022 to December 2024 were included into study.A retrospective analysis was conducted on general information，clinical manifestations，laboratory tests，imaging findings，treatment plans，and outpatient follow-up results of these 5 children.This study was approved by the Ethics Committee of the General Hospital of Ningxia Medical University （Ethics Approval No.KYLL-2025-0152），and informed consents were obtained from the guardians of the children for their diagnosis and treatment.

Results

①Among the 5 children，3 cases were male and 2 cases were female，with ages ranging from 3 to 13 years.The clinical manifestations of the 5 children were primarily characterized by recurrent fever，with some children presenting with abdominal pain，vomiting，and urinary tract irritation signs.One child exhibited tenderness on renal percussion，while no other positive physical signs were observed.②Before treatment，all 5 children had elevated peripheral blood white blood cell count（WBC），C-reactive protein （CRP），and erythrocyte sedimentation rate （ESR）.Two children had increased urinary leukocytes，and one child had a positive urine culture，with the pathogen identified as Escherichia coli.③After admission，all 5 children underwent color Doppler ultrasound of the urinary system，enhanced CT of the kidneys，or MRI.Among them，left renal abscess was found in 3 children，and right renal abscess in 2 children.Upper pole abscess was present in 3 children，and lower pole abscess in 2 children.Three children had renal abscess diameters less than 3 mm，while 2 children had diameters greater than 3 mm.Three children exhibited hydronephrosis.Color Doppler ultrasound of the urinary system showed hypoechoic masses within the renal parenchyma with unclear borders，with diameters ranging from 1.7 to 5.0 cm.MRI of the kidneys revealed patchy abnormal signals within the renal parenchyma，with high signal intensity on diffusion-weighted imaging（DWI）and unclear borders；enhanced scanning showed heterogeneous enhancement of the lesions.④All children received conservative treatment.Initial treatment involved intravenous infusion of broadspectrum antibiotics （piperacillin-tazobactam，meropenem，or ertapenem）for anti-infection therapy.However，the therapeutic effect was unsatisfactory，leading to an upgrade in antibiotic treatment.⑤After discharge，all children continued oral antibiotic therapy for more than 14 days.Follow-up within 2 weeks after discharge showed complete resolution of renal abscesses without renal scar formation.No recurrence was observed during the outpatient follow-up period after discontinuation of medication.

Conclusions

The use of broad-spectrum antibiotics for the treatment of pediatric renal abscesses has proven to be effective and can be recommended as the first-line therapeutic approach.

Objective

To explore the influence of cervical polypectomy during pregnancy on the pregnancy outcome of pregnant women，and the influencing factors of pregnancy outcome of pregnant women with cervical polyps.

Methods

A total of 97 pregnant women with cervical polyps who underwent regular prenatal examination in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2019 to December 2022 were selected as the study objects.The clinical data were analyzed retrospectively.According to whether cervical polypectomy was performed during pregnancy or not，they were divided into operation group （n=25，accept cervical polypectomy）and non-operation group （n =72，not accept cervical polypectomy）.Independent-samples t test，chi-square test and Mann-Whitney U test were used to compare the general clinical data and the clinical data related to pregnancy outcome between two groups.Multivariate logistic regression analysis was used to analyze the influencing factors on the pregnancy outcome of pregnant women with cervical polyps in two groups.This study was approved by the Ethics Committee of our hospital （Approval No.2024218x），and all pregnant women gave informed consent to diagnosis and treatment.

Results

①The rate of preoperative vaginal bleeding，the bleeding duration of vaginal bleeding and the longest diameter of cervical polyps in operation group were 76.0%，7.00 d （0.25，30.00 d）and 2.5 cm（1.9，3.0 cm），respectively，which were higher，longer and larger than those of 26.4%，0 d（0，0.50 d）and 1.0 cm（0.5，1.4 cm）in non-operation group，and the differences were statistically significant （χ²=19.17，P＜0.001；Z=-5.15，P＜0.001；Z=-4.58，P＜0.001）.②There were no significant differences in spontaneous abortion rate，preterm birth rate，full-term birth rate，cesarean section rate，preterm membranes premature rupture rate and neonatal birth weight between 2 groups （P＞0.05）.③There were no significant differences in the incidence of postoperative vaginal bleeding，spontaneous abortion，premature delivery，full-term delivery and premature rupture of membranes between cervical polyps and cervical decidual polyps pregnant women in operation group（P＞0.05）.④Vaginal bleeding of pregnant women with cervical polyps （OR=9.836，95% CI：1.948-49.659，P=0.006）was an independent risk factor for full-term pregnancy in non-operation group.No independent influencing factors were found for pregnancy outcomes in operation group.

Conclusions

Cervical polypectomy during pregnancy does not increase the risk of miscarriage and premature delivery in pregnant women with cervical polyps.For those with vaginal bleeding symptoms and cervical polyps enucleation were not performed during pregnancy，may affect their full-term pregnancy.

Objective

To investigate the efficacy and influencing factors of the Chinese Children's Leukemia Group （CCLG）-acute myeloid leukemia （AML）-2015 protocol in children with newly diagnosed AML.

Methods

From August 2015 to December 2019，a total of 154 newly diagnosed AML children who were treated at the Department of Pediatric Hematology-Oncology，West China Second University Hospital，Sichuan University were included in the study.The efficacy of the CCLG-AML-2015 protocol and its influencing factors were analyzed.The chi-square test was used to compare the composition ratios among children with different risk groups.Kaplan-Meier method was employed to plot survival curves，and the log-rank test was used to compare overall survival（OS）and event-free survival（EFS）rates among different risk groups.Univariate and multivariate analyses of factors affecting OS were performed using the Cox proportional hazards regression model.This study was in line with WorldMedicalAssociationDeclarationofHelsinki revised in 2013 and informed contents were obtained from all guardians.

Results

①Among the 154 newly diagnosed AML children，the majority were male （53.9%），classified as high-risk（55.2%），AML-M2 subtype （50.0%），initial white blood cell count ＜100×10⁹/L （83.8%），abnormal karyotypes （68.8%），positive fusion genes （59.1%），and with gene mutations （72.1%）.②There was significant differences in complete remission（CR）rates after the first induction therapy（χ²=9.39，P =0.009）and after the second induction therapy （χ² =8.08，P =0.018），as well transplantation rates （χ²=19.75，P＜0.001）among children with low，intermediate and high risk.③In the 154 children，33 cases （21.4%）experienced relapse.Treatment was discontinued in 25 cases（16.2%），who were subsequently lost to follow-up.④With a median follow-up of （54.2±1.8）months，the 5-year OS and EFS rates were （67.5±4.1）%and （57.5±4.5）%，respectively.Compared to children with high risk，the children with low and intermediate risk had significantly higher OS rate ［（88.1±4.7）%vs（72.6±5.4）%］and EFS rate ［（73.8±4.8）%vs （56.8±5.0）%］ （χ²=5.21，P=0.022； χ²=7.87，P=0.005）.⑤Falling to achieve CR after the first induction therapy （HR=2.609，95% CI：1.450-4.695，P=0.001）and relapse （HR=2.801，95% CI：1.546-5.076，P=0.001）were independent protective factors for newly diagnosed AML children.

Conclusions

The CCLG-AML-2015 protocol demonstrates significant efficacy in improving remission and survival rates in newly diagnosed AML children.Risk stratification and response to initial induction therapy are crucial factors influencing their survival outcomes.

Uterine perivascular epithelioid cell tumor （PEComa）is a rare mesenchymal neoplasm characterized by distinctive histological，immunohistochemical，and genetic features，along with non-specific clinical manifestations and atypical imaging characteristics.Preoperative diagnosis is arduous，and it is frequently misdiagnosed as uterine fibroids，uterine sarcoma，or other uterine tumors.To date，only a limited number of cases of uterine PEComa have been reported，and there is no standardized consensus on diagnosis and treatment of PEComa.Surgery remains the preferred treatment option，and the efficacy of adjuvant therapy is still controversial.Nevertheless，recently，targeted therapy with mechanistic target of rapamycin （m TOR）inhibitors appears to have achieved superior efficacy.The author intends to elaborate on the origin，definition，epidemiological characteristics and causes of PEComa，as well as the characteristics，classification criteria，clinical manifestations，imaging diagnosis and differential diagnosis of uterine PEComa，and the latest research status of uterine PEComa treatment，aiming to provide reference for subsequent research on this disease.

Fetal tethered cord syndrome（TCS）is a common congenital neural tube malformation that causes neurological and urinary symptoms with varying d egrees after birth.With the increase of people's awareness of health care during pregnancy and rapid development of prenatal imaging t echnology，the prenatal diagnosis of fetal TCS or suspected fetal TCS are gradually increasing.However，there are very few literature reports on the perinatal diagnosis and management of fetal TCS.Once fetal TCS is diagnosed during pregnancy，a multi-disciplinary team（MDT）is required to jointly evaluate the fetal prognosis，make detailed prenatal clinical consultations，and provide individual protocols for TCS fetuses according to different pathogenesis of fetal TCS.This paper intends to focus on the the latest research progress on etiology，pathogenesis，classification and combined other malformations，as well as prenatal diagnosis and management，outcome and prognosis of TCS fetuses，in order to provide reference and suggestions for clinical consultation on TCS fetuses.

Objective

To explore the clinical characteristics of Mollaret meningitis（MM）in children.

Methods

One child with MM （child 1）who visited Shanghai Children's Medical Center，Shanghai Jiaotong University on March 3，2022 was selected as the research subject.A retrospective analysis method was adopted to analyze the clinical data such as the medical history，admission physical examination，relevant examination results and diagnosis and treatment process of child 1.With"Mollaret meningitis"and "child"as key words both in Chinese and English，the relevant literature of MM children were searched from Wanfang Knowledge Service Platform，CNKI，VIP and Pub Med.The literature retrieval time was set from the establishment of each database to December 30，2024.The procedures followed in this study was complied with the requirements of the Helsinki DeclarationoftheWorldMedicalAssociation revised in 2013.

Results

①Child 1 is a 12 years and 11 months old boy.He was admitted to Shanghai Children's Medical Center，Shanghai Jiaotong University due to"intermittent fever for half a year and headache for more than 2 months".After admission，the child 1 was treated with comprehensive treatments including cefotaxime，meropenem，vancomycin，and acyclovir for anti-infection，mannitol and concentrated sodium for reducing intracranial pressure，methylprednisolone for anti-inflammation，and immunoglobulin G supportive therapy.The child's condition improved several times，and he had no complaints of discomfort during the period of temperature relief.However，after the improvement，he developed fever and headache for unknown reasons three times.The results of cranial MRI examination showed enhancement of the bilateral frontal，temporal，and parietal-occipital pia mater，and meningitis was considered first；the bilateral paraventricular vascular spaces were widened，and the cistern magna was slightly enlarged.During hospitalization，cerebrospinal fluid was collected by lumbar puncture for examination for a total of 9 times.Among them，the white blood cell count，cerebrospinal fluid pressure and protein were high during 3 attacks，while the rest cerebrospinal fluid indicators were basically normal.No pathogens were detected in four next-generation sequencing（NGS）of cerebrospinal fluid and one NGS of meningeal tissue.Further hematological examinations did not reveal autoimmune or infectious diseases.The whole exome gene sequencing analysis results of child 1 and his father showed no abnormalities.Combined with the child's examination results and the course of the disease，he was clinically diagnosed as MM.Therefore，all anti-infective drugs were discontinued and only low-dose prednisone（15 mg/d×7 d，reduced to 10 mg/d×14 d，and then reduced to 5 mg/d for continuous oral administration）and mycomfetil capsules（500 mg per dose，twice daily，for a total of 60 days）were taken orally.One month before discharge，the temperature of child 1 was stable and there were no complaints of discomfort.The child 1 was discharged on June 3，2022.After discharge，telephone follow-up was conducted until the end of May 2024，he discontinued prednisone and mycophenolate mofetil capsules for more than one year，and there were no complaints of discomfort.②Literature review results：A total of 12 related literature on pediatric MM were retrieved，involving 15 children with MM，including child 1，a total of 16 cases.Among them，5 were male and 11 were female.The age of 1 case was unknown，and the ages of the remaining 15 cases ranged from 2 years and 6 months to 18 years.All of 16 children presented with fever and headache.One case was positive for the pathogen of herpes simplex virus （HSV）-1，three cases were caused by spinal cysts，and remaining 12 cases had no clear cause.The white blood cell counts of cerebrospinal fluid in all of 16 children during the attack period increased，and 9 cases were significantly increased，and the cerebrospinal fluid protein significantly increased in 9 cases during the attack period.Only 6 cases had Mollaret cells detected in the cerebrospinal fluid during the attack period.Cerebrospinal fluid pressure was reported in 5 cases，among which the cerebrospinal fluid pressure was significantly elevated in 4 cases.Ten cases were misdiagnosed as purulent/viral meningitis before being diagnosed with MM and were treated with antibacterial and antiviral drugs.All of 16 cases had a history of multiple recurrent attacks.The treatment mainly focused on etiological and symptomatic treatment.After treatment，except for child 2 who had epileptic seizures，the prognosis of the remaining 15 children was good.

Conclusions

Pediatric MM is rare in clinical practice and is prone to misdiagnosis.Clinically，for those with more than 2 recurrent episodes of meningitis，abnormal white blood cell count，protein and pressure in cerebrospinal fluid during the attack period，and a short-term recovery after treatment，MM should be considered.Treatment of MM child is mainly symptomatic based on finding possible related causes.

Objective

To investigate the safety of mucous fistula refeeding（MFR）in neonates after enterostomy.

Methods

Literature on clinical research of safety of MFR treatment in neonates after enterostomy were searched by computer from Pub Med，Embase，Cochrane Library，Web of Science，CNKI，VIP，Wanfang Database and Full-Text Database of Chinese Medical Journals.Literature retrieval time was set from database inception of each database to July 10，2024.Review Manager 5.4 software was used to screen and extract literature on the safety of MFR implementation after neonatal enterostomy.The Cochrane Handbook for Systematic Reviews'Risk of Bias 2 and the Newcastle-Ottawa Scale（NOS）for cohort studies were respectively applied to evaluate the quality of randomized controlled trials（RCT）and cohort studies on the safety of MFR after neonatal enterostomy，followed by a Meta-analysis.In this study，the evaluation index of MFR treatment safety in neonates after enterostomy was mainly the incidence of postoperative complications related to enterostomy.Egger's test was used to evaluate literature publication bias.

Results

According to the literature search strategy established in this study，23 pieces of literature（1 exploratory RCT study，11 cohort studies，and the rest were not included in the control group）on the safety of MFR after neonatal enterostomy were included in this study，including a total of 806 neonates after enterostomy.In 12 of the 23 pieces of literature，the study group was neonates after enterostomy who received MFR treatment （n=403），and the control group was neonates after enterostomy who did not receive MFR treatment （n=241）.The analysis was as follows.①Meta-analysis：the results of literature quality evaluation showed that all the 11 cohort studies were of medium or high quality.One RCT study had a high risk of bias（due to the small amount of data included in the literature，it was excluded even if it was a high risk of bias）.The results of Meta-analysis showed that there was no significant difference in the incidence of postoperative complications related to enterostomy between study group and control group ^（RR=0.71，95% CI：0.23-2.15，P=0.54）.There was no significant difference in the incidence of postoperative complications of enterostomy in preterm infants （birth gestational age＜37 weeks）and low birth weight infants （birth weight＜2.5 kg）among those treated with MFR after enterostomy in study group and those not treated with MFR in control group （RR=0.72，95% CI：0.02-29.70，P=0.87；RR=0.11，95% CI：0.01-1.57，P=0.10）.Egger's test results showed that there was no significant publication bias among the studies（P=0.35）.②Systematic review：the total incidence of postoperative complications related to enterostomy reported in 23 pieces of literature was 8.8%（71/806），among which the serious complications were repeated intestinal mucosal bleeding requiring blood transfusion（1 case）and distal intestinal perforation（4 cases），and 2 cases eventually died due to severe infection and multiple organ failure.The mortality rate was 0.2%（2/806）.

Conclusions

MFR is generally safe in neonates after enterostomy，but serious complications can occur.Due to the limited number and quality of included studies，the above conclusions need to be verified by more high-quality studies.

Objective

To explore the clinical characteristics and diagnosis of children with neurofibromatosis type 1（NF1）complicated with nephrotic syndrome（NS），and to investigate the potential association mechanism between NF1 and NS through a literature review.

Methods

A 12-year-old male child with NF1 complicated with NS （Child 1）who was admitted to the Hubei Maternal and Child Health Hospital affiliated to Huazhong University of Science and Technology in February 2021 was selected as the research subject.A retrospective analysis was conducted to collect the clinical data，whole-exome sequencing（WES）results，and Sanger sequencing validation results of child 1.The pathogenicity of the detected variants was analyzed according to the guidelines established by the American College of Medical Genetics and Genomics （ACMG）.Keywords such as"neurofibromatosis type 1""nephrotic syndrome""nephritis"and their English equivalents were used to search relevant literature in databases such as Wanfang Data Service Platform，China National Knowledge Infrastructure （CNKI），and Pub Med.The search period was set from January 1，2001，to December 30，2024.This study adhered to the requirements of the revised 2013 DeclarationofHelsinkiofthe WorldMedicalAssociation.Informed consent was obtained from the guardians of the child.

Results

①Child 1，a boy，was admitted to the pediatric nephrology and rheumatology immunology department of Hubei Maternal and Child Health Hospital on January 14，2021，due to"generalized edema for 2 days".Physical examination upon admission revealed café-au-lait spots over the entire body，multiple small freckles in both axillae，and two tumors approximately 0.5 cm in size in the right renal area.Laboratory tests showed massive proteinuria，hypoalbuminemia，and hyperlipidemia，leading to a diagnosis of NF1 complicated with NS.After admission，the child was treated with adequate glucocorticoids to induce remission，and proteinuria turned negative before discharge.Seven days after discharge，the child again presented with proteinuria without any identifiable cause.Renal biopsy histopathological examination suggested podocyte lesions.Whole-exome sequencing（WES）revealed a deletion mutation （6361-6362del TC）in exon 42 of the NF1 gene on chromosome 17（NM_001042492），causing a frameshift variant，which met the ACMG pathogenicity criteria.Treatment with methylprednisolone tablets combined with tacrolimus was administered，and proteinuria turned negative again before discharge.②Literature review：A total of 17 patients were included，aged 3 to 70 years，with childhood-onset in 5 cases （29.4%）.Ten cases （58.8%）were confirmed to have NF1 through genetic testing.The types of renal injury associated with NF1 included membranous nephropathy，focal segmental glomerulosclerosis （FSGS），and Ig A nephropathy.

Conclusions

NF1 complicated with NS is clinically rare，and genetic testing is crucial for a definitive diagnosis.Abnormalities in the m TOR signaling pathway may mediate podocyte damage，leading to proteinuria.Combined treatment with glucocorticoids and immunosuppressants may be an effective therapeutic approach.

In assisted reproductive technology （ART），the window of implantation（WOI）and endometrial microbiome are crucial for the successful implantation of embryos and pregnancy.WOI refers to endometrial receptivity（ER），which allows the best time for embryo implantation and subsequent pregnancy.Impairments in WOI and microbial imbalances can reduce the success rate of ART and increase the risk of recurrent implantation failures（RIF）and adverse pregnancy outcomes.Although various methods exist to assess endometrial WOI and microenvironment by endometrial microbiological testing （EMT），they face numerous limitations and challenges in clinical application.With the advent of personalized embryo transfer （p ET）strategies，there is an increasing demand for precise understanding and manipulation of the WOIand endometrial microbiome.This review explores recent advancements in study of WOI and endometrial microbiome within context of p ET，aiming to enhance success rate of ART and provide a theoretical foundation and practical guidance for future research directions of ART.

Objective

To explore the clinical manifestations，diagnosis，treatment，and prognosis of elderly female patients with multiple plasmacytoma of spine （MPS）.

Methods

A case of elderly female MPS （patient 1）diagnosed in the 72nd Group Army Hospital of the Chinese People's Liberation Army in July 2024 was selected as the research subject.A retrospective study was conducted to analyze the medical history，clinical manifestations，imaging，and pathological examination results of patient 1 after admission，as well as the diagnosis and treatment process.The literature review of MPS-related research in domestic and foreign databases was conducted using the search strategy set in this study.This study was approved by the Medical Ethics Committee of the 72nd Group Army Hospital of the Chinese People's Liberation Army （Approval No.2024-6）.

Results

The admission-related examinations，admission diagnosis and treatment results of patient 1 were as follows.①Medial history and orthopedic examination：Patient 1 was a 78-year-old female who had neck，back and left upper limb pain for more than 3 months without obvious cause.Orthopedic examination showed obvious neck and back tenderness，slightly limited stretching and rotational movements，and decreased sensation in the left neck，shoulder，and left fingers.②Laboratory examination after admission：The red blood cell count（RBC）was 3.12×10¹²/L，hemoglobin（Hb）was 79 g/L，and fibrinogen was 1.81 g/L，all of which were lower than normal，and the globulin was 50.6 g/L，which was higher than normal.③Post-admission imaging examination：Cervical spine CT showed lytic bone destruction of the C5 spinous process，C7 spinous process，vertebral arch，transverse process，and part of the vertebral body，and the local edge of bone cortex was hardened，and a soft tissue density shadow was shown in it.Cervical spine MRI showed T1-weighted iso intensity and T2-weighted iso intensity in C5 spinous process，C7 spinous process，vertebral arch，transverse process，and and part of the vertebral body.And fat suppression sequences had hyperintensity，slightly elevated intensity in diffusion-weighted imaging ^（DWI），and hypointensity in apparent diffusion coefficient（ADC）images.These areas showed homogeneous enhancement in the enhancement scan，with clear borders，and the spinal cord was markedly compressed.④Treatment and intraoperative resection histopathology and immunohistochemistry results：Patient 1 underwent posterior cervical incision，C7 vertebral lumpectomy，spinal cord release，and vertebral fixation under general anesthesia，and the C7 vertebra had cortical destruction.The tumor was cystic and encapsulated，with a jelly-like opening and a soft texture.The cyst wall of the mass was adherent to the dura mater.Histopathology of intraoperative resection tissue and immunohistochemistry revealed positive results for CD138（+），CD38（+），and Ki-67（+，approximately 30%）.The pathologic diagnosis was plasmacytoma.After the operation，neck pain and numbness，and pain in the left upper limb of patient 1 were significantly improved，her neurological function was significantly r estored.⑤Literature search results：Two pieces of MPS related literature were retrieved in domestic and foreign databases，involving 9 patients （patients 2-10），plus patient 1 in this study，a total of 10 MPS patients.Among these 10 patients，8 cases （patients 2-9）progressed from solitary plasmacytoma of spine（SPS）to MPS，and 1 case （patient 10）was clinically diagnosed as MPS after double lower limb paralysis.Two cases （patients 1 and 10）was treated with surgery alone，2 cases （patients 2 and 7）were treated with surgery combined with radiotherapy，1 case （patient 6）was treated with surgery combined with radiotherapy and chemotherapy，2 cases （patients 5 and 8）were treated with chemotherapy combined with radiotherapy，and 3 cases （patients 3，4，and 9）were treated with radiotherapy alone.Four patients （patients 1，2，7，and 8）had a good prognosis；2 patients （patients 3 and 9）progressed to multiple myeloma（MM），1 patient （patient 3）was still alive at the end of follow-up，and 1 patient （patient 9）died；3 patients （patients 5，6，and 8）progressed to leukemia，and 2 patients （patients 5 and 6）died，and 1 patient（ patient 8）was still alive at the end of follow-up；1 patient （patient 10）was discharged 14 d after surgery and was lost to follow-up，and 1 patient（patient 4）was lost to follow-up after discharge.

Conclusions

In this study，one elderly female patient with MPS who mainly had multiple appendages involved in the lower cervical segment was diagnosed by combining laboratory and imaging examinations and intraoperative resection histopathological examination.There are few reported MPS patients at home and abroad，and the treatment of patients with MPS is mainly radiotherapy and chemotherapy，appropriate surgery can improve the patient's neurological function and alleviate the corresponding pain symptoms in time.

Objective

To investigate the clinical manifestations and early renal involvement in pediatric patients with primary Sjögren's syndrome （pSS）.

Methods

A total of 30 pediatric patients with pSS who were hospitalized in the Department of Rheumatology and Immunology，Capital Center for Children's Health，Capital Medical University，between January 2017 and January 2023 were included in this study.A retrospective analysis was conducted on their general clinical data，laboratory test results，renal involvement，and prognosis.This study followed the procedures in accordance with the DeclarationofHelsinkioftheWorldMedicalAssociation revised in 2013.

Results

①Among the 30 children with pSS，the male-to-female ratio was 1∶5.The age of onset and the age at diagnosis were （8.9±3.8）years and （10.3±3.4）years respectively.The predominant systemic manifestations included recurrent glandular swelling or parotitis （23/30，76.7%），hematologic involvement（17/30，56.7%），localized cutaneous vasculitis （12/30，40.0%），erythema multiforme （2/30，6.7%），and diffuse cutaneous vasculitis （1/30，3.3%）.②Laboratory examinations revealed that among 30 cases，14 cases（46.7%）showed labial salivary gland atrophy with multifocal lymphocytic infiltration in the interstitium，and the number of lymphocytes in each focus exceeded 50.Additionally，3 cases（10.0%）underwent sialography，which demonstrated punctate to small saccular dilation of the terminal ducts with incomplete emptying.③Among the 30 children with pSS，the mean European League Against Rheumatism （ESSDAI）score was 14.7±7.8，indicating moderate to severe disease activity.None of the children had neurological involvement.Serum abnormalities were present in 24 cases （80.0%），glandular involvement in 23 cases （76.7%），and hematologic involvement in 17 cases （56.7%），with thrombocytopenia being the predominant manifestation.Skin lesions of varying degrees were observed in 15 cases （50.0%）.Among the 30 children with pSS，5 cases（16.7%）exhibited trace to mild proteinuria（±to+），and 4 cases （13.3%）had abnormal elevation in 24 h urinary protein excretion （153.7～787.8 mg/d）.The prevalence of early renal involvement in children with pSS was relatively high （90.9%，20/22），with a higher incidence of early tubular injury（86.4%，19/22），although the severity was mild.The incidence of early glomerular injury was 31.8%（7/22）.The treatment for the 30 children with pSS primarily consisted of oral corticosteroids，immunosuppressive agents，and hydroxychloroquine sulfate （HCQ）.Among them，23 children were followed up for a median duration of 17 months （ranging from 7 to 38 months）.During this period，21 patients achieved stable clinical symptoms，normalized inflammatory markers，and no disease relapse was observed during the gradual tapering of corticosteroids.

Conclusions

The primary clinical manifestations and affected systems in pediatric pSS include recurrent glandular swelling/repeated parotitis，followed by hematologic involvement.Recurrent parotitis should be considered as one of the diagnostic criteria for pediatric pSS.With active treatment，most children with pSS achieve stable clinical symptoms during follow-up.The incidence of early renal involvement in pediatric pSS is relatively high，especially the rate of renal tubular injury.Renal biopsy should be actively performed in children with pSS.

Precocious puberty in girls is a common developmental abnormal disease in the field of pediatric endocrinology，and its incidence is increasing year by year.Precocious puberty in girls is categorized into three subtypes：central precocious puberty （CPP），peripheral precocious puberty（PPP），and incomplete precocious puberty ^（IPP）.Among them，the pathological mechanism of CPP is primarily linked to the initial activation of the hypothalamic-pituitary-gonadal axis （HPGA），and its diagnosis depends on clinical manifestations，serum basal sex hormone levels and gonadotropinreleasing hormone （GnRH）stimulation test.However，due to the time-consuming，high cost，and high compliance requirements for children in GnRH stimulation testing，finding more convenient and non-invasive alternative means for screening of precocious puberty has become a research hotspot in this field.The detection of serum basal sex hormones holds significant clinical value in the screening of precocious puberty in girls，especially in evaluating the extent of HPGA activation.Given its simplicity and low cost，it can be employed as a primary screening tool for precocious puberty in girls，minimizing the need for unnecessary GnRH stimulation tests.In recent years，the application of pelvic ultrasound for diagnosing precocious puberty in girls has garnered significant focus.As a noninvasive，economical and easy to operate imaging technique，pelvic ultrasound provides an important basis for early screening and classification of precocious puberty in girls by measuring uterine volume，endometrium thickness and ovarian volume.The article systematically expounds the application value of serum basal sex hormone level detection and pelvic ultrasound in the diagnosis of precocious puberty in girls，providing a reference for pediatric clinicians in diagnosing precocious puberty in girls.