We report an acute myocardial infarction patient with respiratory cardiac arrest in whom conventional cardiopulmonary resuscitation was invalid and extracorporeal cardiopulmonary resuscitation (ECMO) was performed. During ECMO, bloodstream infections caused septic shock. With the assistance of ultrasound and other techniques, cardiac function and volume status were evaluated, which provided a basis for making rational clinical decision. After shock resuscitation and anti-infection treatment, the patient's condition improved.

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.

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 study the characteristics of periostin， tenascin-C （TNC）， and soluble human matrix metalloproteinase-2 （sST2） levels in asthmatic children infected with Mycoplasma pneumoniae and their impact on acute asthma exacerbations.

Methods

A total of 187 asthmatic children with mycoplasma pneumoniae infection who were hospitalized and treated in our hospital from May 2020 to October 2022 were selected， including 104 males and 83 females， with ages ranging from 10 to 14 years and a mean age of（12.07±1.25） years. The children were categorized into two groups： a remission group （n=134） and an acute exacerbation group （n=53）， based on the presence of acute asthma exacerbation. A comparison was made between the two groups in terms of general clinical characteristics， as well as serum levels of periostin， TNC，and sST2. Univariate and multivariate logistic regression analyses were conducted to ascertain whether serum periostin， TNC， and sST2 levels could independently predict the risk of acute exacerbations in children with asthma infected by Mycoplasma pneumoniae. Through the use of receiver operating characteristic （ROC）curves， cutoff values for serum periostin， TNC， and sST2 were identified. Based on the results of multivariate logistic regression analysis， a risk prediction nomogram model incorporating serum periostin， TNC， and sST2 was constructed. The model degree of fitting was evaluated using Hosmer-Lemeshow test and calibration curves， the predictive performance was assessed through ROC curve analysis， and the clinical application value was evaluated using decision curve analysis （DCA）.

Results

Compared to the remission group， the acute exacerbation group had a lower proportion of regular use of inhaled corticosteroids （ICS）， a lower forced expiratory volume in one second/forced vital capacity ratio （FEV1/FVC），and forced expiratory volume in 1 second as a percentage of predicted value （FEV₁/pred）， and higher levels of serum periostin， TNC， and sST2（P＜0.05）. ROC analysis indicated that the AUC values for serum periostin， TNC， and sST2 in predicting acute exacerbations in children with asthma infected by Mycoplasma pneumoniae were 0.673， 0.737， and 0.720， respectively. Multivariate logistic regression analysis indicated that high periostin ［OR （95%CI）=1.031 （1.014～1.049）］， high TNC ［OR （95%CI）=1.099 （1.055～1.144）］， and high sST2 ［OR （95%CI）=1.171（1.080～1.271）］ were all independent risk factors for acute exacerbations in children with asthma infected by Mycoplasma pneumoniae （P＜0.05）. The nomogram model constructed based on the aforementioned three indicators demonstrated favorable degree of fitting （Hosmer-Lemeshow test： χ²=7.356， df=8， P=0.499）. ROC analysis revealed that the AUC value of this nomogram model for predicting acute exacerbations in pediatric patients was 0.838 （95% CI： 0.779～0.898， P＜0.001）. DCA analysis indicated that this nomogram prediction model exhibited satisfactory clinical net benefit across a threshold probability range of 0～0.95.

Conclusion

The levels of serum periostin， TNC， and sST2 in children with asthma complicated by Mycoplasma pneumoniae infection are strongly correlated with the likelihood of experiencing acute asthma exacerbations.Utilizing a model that incorporates these serum biomarkers can greatly assist healthcare providers in assessing the risk of acute asthma exacerbations in this specific group of children， thereby demonstrating significant clinical utility.