Background

Anterior shoulder instability （ASI） is a common disease in sports medicine， mainly in young people and athletes， and is usually caused by external forces encountered when the arm is in an extreme abduction and rotation position. The incidence of ASI is 23.9 cases per 100 000 people per year， accounting for 95% of all shoulder dislocations. Due to the contact and compression of the anterior humeral head with the subscapular anterior inferior margin， this injury is usually accompanied by anterior glenolabial and soft tissue injury and posterolateral depression of the humeral head. Hill-Sachs injury occurs in about 67% to 69% of patients in the first dislocation. Hill-Sachs defects increase the risk of laboplasty failure and make patients more prone to re-dislocation，which further leads to structural damage and dysfunction of the glenohumeral joint. In recent years，research has shown that for the first time， dislocation after arthroscopic surgery treatment can significantly reduce the recurrence rate and increase the chances of recovery movement under the arthroscope Bankart repair （arthroscopic Bankart repair， AB）， used to be the gold standard for patients with anterior and inferior labrum tears， Hill-Sachs injuries accounting for less than 20% of the humerus head and no critical bone defect in the anterior pelvis， but studies have shown a high recurrence rate after surgery. Remplissage was first proposed by Conolly et al.， which mainly filled the subincaudal tendon and joint capsule to the Hill-Sachs injury site of the humerus head. Studies have shown that arthroscopic Bankart repair with Remplissage （ABR） combined with AB may reduce the recurrence rate of patients with Hill-Sachs injury， but the benefits of its treatment are still controversial. Surgery such as Remplissage may increase the loss of external rotation Angle after surgery. Meta-analysis can systematically integrate and quantitatively analyze the results of multiple independent studies， improve the statistical efficiency of the study， reduce the contingency and bias of the results of a single study，and help draw more reliable conclusions. Although the efficacy of AB and ABR has been investigated in different studies， results have been inconsistent due to differences in study design， sample size，and outcome measures. Due to the differences in design， outcome indicators， and other aspects of existing studies， meta-analysis helps provide a more accurate and objective effect assessment for AB and ABR treatment of Hill-Sachs injury. It provides more robust evidence to support clinical decisionmaking.

Objective

To evaluate the clinical efficacy of AB combined with ABR in the treatment of shoulder joint forward instability ASI with Hill-Sachs injury by meta-analysis.

Methods

PubMed，Scopus， Embase， Cochrane Library， and Web of Science databases were searched to collect randomized controlled trials， case-control studies， and cohort studies related to AB and ABR treatment of ASI with Hill-Sachs injury. Stata 17.0 was used for statistical analysis.

Results

A total of 18 studies were included， involving 1，515 patients. Compared with AB group， ABR group had significantly lower recurrence rate （OR=0.19， 95% CI：0.12-0.32， P＜0.001）， secondary surgery rate （OR=0.16， 95% CI： 0.07-0.38， P＜0.001）， and complication rate （OR=0.07， 95% CI：0.01-0.49， P=0.007）， and the recovery of motion was better （OR=4.96， 95% CI：1.75-14.03， P=0.003）. However， the two groups had no statistically significant differences in lateral rotation Angle （MD=-6.99， 95% CI： -15.64-1.66， P=0.113）and joint function scores. Sensitivity analysis and publication bias evaluation showed that the results were robust.

Conclusion

ABR was superior to AB in reducing the recurrence rate， secondary operation rate， and complication rate of shoulder forward instability with Hill-Sachs injury， but the difference in postoperative functional recovery was insignificant.

Background

The elbow joint is one of the important joints in the human body， located in the middle of the upper limb， coordinating the activities and functions of the shoulder and wrist joints.Currently， with the rapid development of society and the increase of injuries such as traffic accidents， elbow joint injuries are gradually increasing. Post-traumatic fractures of elbow joints are often accompanied by articular surface fractures and incredibly complex intercondylar fractures of the humerus. This kind of fracture is often comminuted， and the preferred treatment for this disease is surgical treatment. Through surgical open reduction and internal fixation， and early postoperative functional exercise， ideal results can be achieved， and the incidence of complications can be reduced. The main surgical approaches were the olecranon osteotomy approach and the triceps lingual flap approach. Currently， the primary surgical approach for type C2 and C3 intercondylar fractures of the humerus is the transolecranon osteotomy approach. The most significant advantage of this approach has been generally accepted， but there are also literature reports with postoperative disadvantages. It is believed that the cross-section diameter of the olecranon itself is small， and after simple osteotomy reduction and fixation， the postoperative reduction and fixation are prone to be unstable due to the thin structure of the osteotomy. The nonunion of fractures in any part of the elbow joint will affect the range of motion of the elbow joint， and it is easy to produce elbow stiffness after surgery. We need to consider how to avoid the occurrence of bone nonunion at the osteotomy， improve the stability of the osteotomy， and start rehabilitation exercises in advance when preparing for surgery and drawing up the surgical plan. Its essence is how to fix the osteotomy of the olecranon better. There are few fixation methods at the olecranon osteotomy， and the main fixation methods are Kirschner wire tension band internal fixation and steel plate internal fixation， and both methods can be used for early postoperative elbow joint function recovery exercise.

Objective

To investigate the risk of postoperative elbow stiffness in intercondylar fracture of the humerus and olecranon osteotomy with different internal fixation methods.

Methods

Forty patients with intercondylar fracture of the humerus admitted to our hospital from January 2012 to January 2024 were selected and divided into the control group （n=18） and the study group （n=22）. The fixation methods of olecranon osteotomy were plate fixation and wire fixation with Kirschner wire and tension band， respectively.The surgical situation， postoperative fracture healing time， complications and pain visual analogue scale（VAS） score， Mayo elbow function score， elbow motion， postoperative infection index， etc.， were observed and compared between the two groups.

Results

Compared with the two groups， the study group's incision length and operation time were shortened， the intraoperative blood loss was decreased， and the postoperative VAS score was decreased （P＜0.05）. Compared with the control group， the study group's postoperative Mayo elbow joint function score was significantly increased （P＜0.05）. Postoperative elbow flexion-extension motion and forearm rotation motion were significantly improved in the study group. There was no significant difference in other observation indexes between the two groups.

Conclusion

The internal fixation with Kirschner and wire tension band for olecranon osteotomy， compared with plate fixation， can shorten the operation time and surgical incision length， reduce intraoperative blood loss， and reduce postoperative pain，which can promote the recovery of elbow motion and improve elbow function. There is also a lower risk of postoperative elbow stiffness than with plate fixation.

Background

Although proximal humeral fractures combined with ipsilateral humeral shaft fractures are rare， in recent years， with the increase of high-energy injuries， the incidence rate has been increasing yearly and can account for 1%-2% of all humeral fractures. Due to its multiple and complex fractures， there are many difficulties in its treatment， and factors such as intraoperative reduction， selection of internal fixation， and functional rehabilitation exercises need to be considered.Traditional treatment mainly adopts conservative treatment， which has a long fixation time and is prone to complications such as nonunion of fractures and joint stiffness. Therefore， more and more patients are adopting surgical internal fixation treatment. Currently， intramedullary nails （IMN） and locking plate osteosynthesis（LPO）may be considered for the fixation of proximal humeral fractures combined with humeral shaft fractures. LPO can provide stable fixation and has strong angular stability. However， the surgery requires extensive dissection of soft tissues and disruption of the periosteal blood supply， which may lead to delayed healing or nonunion of fractures. Although IMN reduces soft tissue dissection injury and enables early weight-bearing activities， its disadvantages include rotator cuff damage and unstable rotation.

Objective

To compare the efficacy of intramedullary nails and locking plates in treating proximal humeral fractures combined with humeral shaft fractures was clarified.

Methods

Based on the inclusion and exclusion criteria， a retrospective analysis was conducted on the clinical data of 41 cases of proximal humeral fractures combined with ipsilateral brachial shaft fractures admitted to the Sixth Affiliated Hospital of Xinjiang Medical University from January 2020 to January 2024. They were divided into the intramedullary nail treatment group （IMN） and the locking plate treatment group（LPO） according to different fixation methods. The operation time， surgical bleeding， incision length，fracture healing time， Constant-murley score（CMS）， and the disabilities of the arm， shoulder，and hand score（DASH） were evaluated.

Results

The average operation time of the LPO group was（92.25±16.18）min， and that of the IMN group was （96.43±22.98）min. The two groups had no statistically significant difference （t=0.670， P=0.507）. The average surgical blood loss in the LPO group was （176.75±91.14）ml， and that in the IMN group was （107.86±26.39）ml. The IMN group was significantly better than the LPO group （t=3.253， P=0.004）. The average incision length of the LPO group was （17.90±4.28）cm， and that of the IMN group was（7.67±0.73）cm. The IMN group was significantly better than the LPO group （t=10.803， P=0.000）. The average fracture healing time in the LPO group was （13.85±1.79）weeks， and that in the IMN group was （12.67±1.24）weeks.The IMN group was significantly better than the LPO group （t=2.476， P=0.018）. The average CMS score of the LPO group was （86.65±6.91）points， and that of the IMN group was（88.29±6.87）points. The two groups had no statistically significant difference （t=0.760， P=0.452）.The average DASH score of the LPO group was （16.00±6.36）points， and that of the IMN group was（12.57±5.11）points. There was no statistically significant difference between the two groups （t=1.909，P=0.064）.

Conclusion

Both LPO and IMN can be used as effective measures for treating proximal humeral fractures combined with ipsilateral humeral shaft fractures. However， IMN shows obvious advantages in reducing surgical bleeding， shortening surgical incision length， and fracture healing time.

Background

Proximal humeral fractures are common upper limb fractures and have a high incidence among middle-aged and older adults， usually caused by low-energy falls. With the intensification of global population aging， the incidence of proximal humeral fractures is also increasing.Recent epidemiological studies have pointed out that the majority of proximal humeral fractures are displaced. Elderly patients， due to osteoporosis and decreased bone density， tend to have more complex fractures when they occur and face more challenges in the treatment process. For displaced and unstable proximal humeral fractures， open reduction and internal fixation remain the preferred treatment methods when bone quality permits. Open reduction and internal fixation not only help restore the anatomical position of the fracture site but also effectively relieve pain and promote early rehabilitation. Proximal humeral fractures are often accompanied by relatively obvious osteoporosis， which makes internal fixation treatment face many difficulties. Osteoporosis leads to bone fragility in the fracture area， which affects the stability of the fixation device and increases the risk of postoperative complications. The most common complication after internal fixation of proximal humeral fractures is the varus deformity of the humeral head. Varus not only affects postoperative shoulder joint function but may also lead to complications such as subacromial impingement， internal fixation failure， and screw protrusion due to changes in the rotation center of the humeral head， resulting in pain and functional disorders in patients. Clinically， for cases with medial cortical fragmentation， methods such as enhancing the internal fixation torque through intramedullary nails or increasing stability through intramedullary fibular bone grafting can prevent the inversion and collapse of the humeral head after surgery. Although these measures can effectively prevent the occurrence of humeral head varus and collapse， the mechanism of changes in the bony structure and internal fixation of the proximal humerus caused by humeral head varus has not been fully clarified so far. The occurrence of varus deformity may be closely related to multiple factors such as fracture type， postoperative reduction condition， bone condition， and the choice of internal fixation. Therefore， in-depth research on the pathological mechanism and imaging manifestations of inversion after proximal humeral fracture surgery has practical clinical significance. Through imaging measurements， especially the evaluation of geometric indicators after humeral head inversion， a basis can be provided for further optimizing the treatment plan.

Objective

To investigate the radiographic characteristics and correlations of varus deformity following locking plate fixation for proximal humeral fractures.

Methods

A retrospective analysis was conducted on patients with locking plate internal fixation of proximal humeral fractures who underwent surgical treatment from September 2014 to September 2024. A total of 53 patients with humeral head inversion after surgery （22 males and 31 females， with an average age of 61.3 years±5.4 years） were screened out. The following parameters were measured by anterior-position X-ray films of the scapula one year after surgery：（1）Humeral head trunk angle （HSA）； （2）Large nodule - acromial distance （GT-AC）； （3）Medial cortical interpolation（MI）； （4）Rotation center height difference（）； （5）Large nodule - humeral head distance. Pearson correlation analysis was used to assess the relationships between various imaging indicators.

Results

HSA was significantly positively correlated with GT-AC （r=0.694， P＜0.001）， HSA was significantly negatively correlated with MI （r= -0.986， P＜0.001）， articular surface-large nodule distance （r=0.063， P=0.656），and （r=0.015， P=0.912） had no significant correlation with the degree of inversion.

Conclusion

The shortening of medial cortical intercalation and the reduction of the distance between the large nodule and the acromion is significantly associated with humeral head inversion. In the clinical assessment of humeral head inversion after proximal humeral fracture surgery， these concomitant pathological mechanisms should be considered.

肩关节骨折是创伤领域的常见疾病，由于肩关节的结构较为复杂且相对不稳定，肩关节骨折的发生率较高。内固定手术是肩关节骨折常用的治疗措施，肩关节骨折内固定术后感染目前也仍是肩关节骨折最具挑战性的并发症之一。肩关节骨折内固定术后感染的危险因素十分复杂，一旦发生就会导致患者的预后与肩关节的功能恢复受到严重影响，常常伴有畸形、慢性疼痛等并发症以及严重的后遗症，同时可能伴有一定程度上的心理问题。目前如何早期地识别肩关节骨折内固定术后感染的发生以及对于治疗方案的选择仍然是亟待解决的难题。本文通过检索国内外关于骨折内固定术后感染相关文献，就肩关节骨折内固定术后感染的分类、原因、危险因素、诊断及治疗的相关进展进行讨论，学习并研究其诊断方式以及治疗方案的选择，旨在为肩关节骨折内固定术后感染的防治提供新的思路。

肩袖损伤是一种常见的肩关节疾病，其恢复效果受到脂肪浸润的显著影响。本文总结了脂肪浸润的影响因素（如年龄、生活方式、肌腱回缩等）、分子机制（如成纤维脂肪祖细胞及相关信号通路）、以及对肩袖肌肉功能和代谢的影响。此外，文章回顾了针对脂肪浸润的治疗策略，包括干细胞疗法、小分子药物及个性化手术方法，强调脂肪浸润在肩袖损伤中的作用及其临床意义。未来研究应聚焦于标准化评估方法、早期干预措施及新型治疗手段，以进一步优化治疗效果和患者预后。

肱骨近端骨折是老年人群体中第三大常见的骨折，随着人口老龄化的不断发展，该型骨折的发生率及其影响也在持续增长。关于老年肱骨近端骨折的治疗方法，目前临床上并没有统一的“金标准”。临床上常见的治疗方式即保守治疗与手术治疗，其中手术治疗包括肩关节置换术、切开复位内固定术等。不同治疗方式各有优劣，临床医师应根据患者的损伤分类、病史、年龄及功能需求设计适宜的治疗方案。本文对近年来老年肱骨近端骨折治疗方面的相关研究进行综述，为临床医师对于老年肱骨近端骨折的治疗选择提供参考。

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 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 explore the construction of a Nomogram discrimination model for distinguishing Mycoplasmapneumoniae（MP）from viral infection in children with communityacquired pneumonia（CAP）and to evaluate its ability to distinguish two types of pneumonia.

Methods

A total of 1 035 children aged 0 to 12 years with CAP who were treated in Dongguan People's Hospital from July 2022 to June 2023 were selected as the research subjects.A retrospective analysis was conducted，according to the results of etiological examination，they were divided into MP group （n=525，with MP infection）and viral group （n=510，with respiratory tract-related viral infection）.The general clinical data，clinical symptoms and signs，laboratory test results，and chest X-ray results between two groups of children were compared statistically （single factor analysis）.Multivariate unconditional logistic regression analysis was used to identify independent influencing factors for distinguishing MP from viral infection in children with CAP，and based on these factors，a Nomogram discrimination model was constructed to distinguishing MP from viral infection in children with CAP.The model's classification accuracy and stability were subsequently validated.This study was approved by the Ethics Committee of Dongguan People's Hospital （Approval No.KYKT2021-065）.

Results

①Multivariate unconditional logistic regression analysis results showed that compared with children aged＞0-12 months，the probability of being diagnosed with MP pneumonia（vs viral pneumonia）in children aged ＞12-36 months，＞36-72 months，and ＞72-144 months were significantly higher，with odds ratios（OR）of 9.98（95% CI：5.26-18.92），47.25（95% CI：24.96-89.45），and 740.87（95% CI：200.27-2 815.14），respectively，and all with P ＜0.001.Increased platelet distribution width （PDW），presence of runny nose，and segmental/patchy infiltrates on chest X-ray were also with higher probability of being diagnosed with MP pneumonia（vs viral pneumonia），with the OR of 0.75（95% CI：0.67-0.83），0.29（95% CI：0.19-0.42），and 3.41（95% CI：2.35-4.94），respectively，and all with P ＜0.001.②A Nomogram discrimination model was developed using these four variables：age，PDW，runny nose，and segmental/patchy infiltrates on chest X-ray.The optimal cutoff score for total points on the Nomogram was 57.4，corresponding to the maximum Youden index of 0.725.The model yielded a concordance index （C-index）of 0.904（95% CI：0.885-0.922，P ＜0.05），with a sensitivity of 94.48%and a specificity of 78.04%.

Conclusions

The Nomogram discrimination model constructed based on four nonspecific clinical indicators（age，platelet distribution width，runny nose symptoms，and segmental/patchy infiltrates on chest X-ray）demonstrates high clinical value and diagnostic accuracy in distinguishing MP from viral infection in children aged 0-12 years old with CAP.However，further external validation is warranted.

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 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.