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中华儿科杂志第十六届编辑委员会第二次工作会议于2022年10月24日在线上召开。.

OBJECTIVE: To explore the relationship between drug treatment and outcomes in patients with late-onset severe pneumonia (LOSP) after allogeneic stem cell transplantation (allo-SCT). METHODS: We retrospectively analyzed the effects of the initiation time of treatment drugs, especially antiviral drugs and glucocorticoids on the clinical outcomes in 82 patients between January 2016 and August 2021 who developed LOSP after allo-SCT in Peking University People's Hospital. Univariate analysis was performed by Mann-Whitney U test and χ(2) test, and multivariate analysis was performed by Logistic regression. When multiple groups (n>2) were involved in the χ(2) test, Bonferroni correction was used for the level of significance test. RESULTS: Of all 82 patients in this study, the median onset time of LOSP was 220 d (93-813 d) after transplantation, and the 60-day survival rate was 58.5% (48/82). The median improvement time of the survival patients was 18 d (7-44 d), while the median death time of the died patients was 22 d (2-53 d). Multivariate analysis showed that the initiation time of antiviral drugs from the onset of LOSP (< 10 d vs. ≥10 d, P=0.012), and the initiation time of glucocorticoids from antiviral drugs (< 10 d vs. ≥10 d, P=0.027) were the factors affecting the final outcome of the patients with LOSP at the end of 60 d. According to the above results, LOSP patients were divided into four subgroups: group A (antiviral drugs < 10 d, glucocorticoids ≥10 d), group B (antiviral drugs < 10 d, glucocorticoids < 10 d), group C (antiviral drugs ≥10 d, glucocorticoids ≥10 d) and group D (antiviral drugs ≥10 d, glucocorticoids < 10 d), the 60-day survival rates were 91.7%, 56.8%, 50.0% and 21.4%, respectively. CONCLUSION: Our study demonstrated that in patients who developed LOSP after allo-SCT, the initiation time of antiviral drugs and glucocorticoids were associated with the prognosis of LOSP, and the survival rate was highest in patients who received antiviral drugs early and glucocorticoids later. It suggested that for patients with LOSP of unknown etiology should be highly suspicious of the possibility of a secondary hyperimmune response to viral infection.

本文报道1例发生于右侧甲状腺的神经鞘瘤患者，肿瘤侵及气管发生呼吸困难，行右侧甲状腺及峡部肿瘤切除+受累气管的切除造口手术。术后6个月行气管造口修补，修补术后随访1年肿瘤无复发，患者呼吸功能良好，伴轻度声音嘶哑。.

慢性鼻窦炎（CRS）是一组高度异质性的疾病，不同内在型的CRS存在差异显著的临床表型、病理特征和治疗预后。基于内在型对CRS进行个体化治疗已取得国内外鼻科专家的共识，但如何根据CRS的内在型进行内镜术式选择目前仍没有结论。本文将通过介绍CRS内在型的分型标准、国人CRS内在型的区域异质性及其与手术疗效的关系，重点阐述基于内在型的CRS内镜鼻窦手术策略，以期提高临床医师对CRS个体化手术治疗的理解。.

和成人慢性鼻窦炎（CRS）相比，儿童CRS的病因、免疫发病机制以及临床表现均显著不同，这也决定了儿童CRS应采用和成人CRS不完全相同的治疗方式和策略。《儿童鼻-鼻窦炎诊断和治疗建议（2012年，昆明）》推动了我国儿童CRS的临床规范诊疗，但近10年又相继出现了许多新的儿童CRS研究成果。本文将结合近年新发表的儿童CRS发病机制、药物和外科治疗等相关文献进行综述，以期为临床医师了解儿童CRS研究进展，并为制订新的儿童CRS诊疗指南提供参考。.

血液系统肿瘤是最常见的恶性肿瘤之一，是影响人们健康的重要疾病。根据中国国家癌症中心2015年数据，血液系统肿瘤的发病率和病死率均位居恶性肿瘤前十位。近年来，血液疾病在发病机制、分子标记、靶向药物等方向均取得了长足的进步乃至重大突破，部分血液恶性肿瘤患者5年生存期上升至60%~90%，逐渐由“不可治愈”变为“可治愈”疾病。但是与此同时，治疗疗效与美国、欧洲等发达国家相比仍有差距，需要进一步的改进，本文提出了一些血液肿瘤治疗待解决的问题及对策，期望引起血液科医师及相关科研工作者的重视。.

中华儿科杂志第十六届编辑委员会第一次工作会议于2020年12月18日在北京成功召开。来自全国的109位编委、特约编委、通讯编委就第十五届编辑委员会工作进行了总结，并对杂志未来发展问题进行了深入的讨论。.

靶向治疗的应用一方面改善了肿瘤的治疗；但另一方面，由于靶向药物所针对的靶点通常也是生理状态下免疫通路或者细胞通路的关键成分，从而损害正常免疫功能，导致包括侵袭性真菌病（IFD）在内的感染性并发症风险增加。靶向治疗的广泛应用已经或正在使对IFD风险的认识及防控策略发生变化。这种变化对于血液科医师在新时代对IFD的认识与诊断提出了新的挑战。.

目的 分析异基因造血干细胞移植（allo-HSCT）后非曲霉属丝状真菌病（NAMI）的临床特点及预后。 方法 回顾性分析2010年1月1日至2016年12月31日在北京大学血液病研究所接受allo-HSCT后诊断（确诊或临床诊断）为NAMI的24例患者，总结其临床特点及预后。 结果 24例移植后NAMI患者，男21例（87.5%），女3例（12.5%），中位年龄33（10~66）岁。NAMI中位发生时间为移植后188（2~856）d，10例为确诊，14例为临床诊断；19例（79.2%）发生在肺部，4例（16.7%）发生在中枢神经系统，1例（4.2%）发生在鼻窦；病原菌分布中根霉菌14例（58.3%）、毛霉菌5例（20.8%）、犁头霉菌3例（12.5%），尖端赛多孢子菌2例（8.3%）；临床症状为发热20例（83.3%），头痛4例（16.7%），咯血、腹痛腹泻、抽搐（颅内感染）各2例（8.3%），胸痛1例（4.2%）。在18例根据病原学结果调整抗真菌治疗的患者中，治疗的有效率为38.9%（7/18）。中位随访时间为自NAMI诊断后229（2~2 280）d，2年总生存率为（24.0±14.5）%。 结论 allo-HSCT后非曲霉菌属丝状真菌感染以根霉菌为主，临床表现缺乏特异性，死亡率高。

Atherosclerosis (AS) is a leading disease with high mortality and morbidity in the world. It has been demonstrated that exosomes can transfer some miRNAs or proteins to regulate the biological functions of human vascular smooth muscle cells (VSMCs) and promote the progression of AS. In this study, we mainly aimed at exploring potential functions of exosomes derived from ox-LDL exposed macrophages and investigating the potential mechanisms of exosome-mediated miR-106a-3p in regulating VSMCs and promoting AS.Ox-LDL was used to treat THP-1 macrophages, CCK-8 assay was performed to detect cell viability, and flow cytometric analysis was used to detect cell apoptosis. Exosomes were isolated and collected with centrifugation, and were determined by transmission electron microscopy and WB assay. RT-PCR was used to detect the expressions of miRNAs in exosomes and VSMCs, WB assay was used to detect protein expressions. MiR-106a-3p mimic was transfected into VSMCs to verify its functions and the Luciferase gene reporter assay was performed to prove the binding site of miR-106a-3p and CASP9. Finally, GW4869, an inhibitor for exosome secretion, was used to block exosome secretion by ox-LDL induced THP-1 and to confirm the effects of miR-106a-3p on cell proliferation and apoptosis in VSMCs.We found that ox-LDL induced THP-1 could promote cell proliferation and repress cell apoptosis of VSMCs, then, exosomes were successfully isolated, which could promote cell proliferation and repressed cell apoptosis of VSMCs after adding into VSMCs. Furthermore, we found that miR-106a-3p was significantly increased in exosomes from ox-LDL induced THP-1 and its expression was also increased in VSMCs after adding into VSMCs. Moreover, miR-106a-3p overexpression could promote cell viability and repress cell apoptosis, as well as regulate associated protein expressions. Additionally, the Luciferase gene reporter assay confirmed that miR-106a-3p could directly bind with CASP9 and regulate Caspase signaling in VSMCs. Finally, blocking exosomes from ox-LDL induced THP-1 reduced the cell viability and promoted cell apoptosis in VSMCs.Above all, this study demonstrated that miR-106a-3p was increased in exosomes from ox-LDL induced THP-1 and it could promote cell proliferation and repress cell apoptosis of VSMCs. We found that the exosomes-mediated miR-106a-3p could directly bind with CASP9 and repress Caspase signaling pathway in VSMCs, which might provide a potential target for treating AS.

目的 探讨脾肿大对慢性粒-单核细胞白血病（CMML）异基因造血干细胞移植（allo-HSCT）预后的影响。 方法 对2004年至2018年在北京大学血液病研究所接受allo-HSCT后的25例CMML患者进行回顾性分析，根据预处理前2周是否伴有脾脏肿大分为脾肿大组和非脾肿大组，比较两组患者在植入、移植物抗宿主病（GVHD）、复发以及生存方面的差异。 结果 ①脾肿大组15例（男8例，女7例），中位年龄45（23~61）岁；非脾肿大组10例（男、女各5例），中位年龄39（12~56）岁。两组患者基线特征差异无统计学意义（P>0.05）。②脾肿大组、非脾肿大组粒细胞植入率分别为93.3%（14/15）、100.0%（10/10），中位植入时间分别为17（11~20）d、14（11~18）d（χ2=5.303，P=0.021）；脾肿大组、非脾肿大组血小板植入率分别为80.0%（12/15）、90.0%（9/10）（P=0.212），中位植入时间分别为17（12~33）d、15（12~19）d（χ2=0.470，P=0.493）。③脾肿大组5例发生急性GVHD（Ⅰ/Ⅱ度4例，Ⅲ/Ⅳ度1例），非脾肿大组6例发生急性GVHD（Ⅰ/Ⅱ度5例，Ⅲ/Ⅳ度1例）（χ2=0.204，P=0.652）。脾肿大组、非脾肿大组移植后100 d的急性GVHD累积发生率分别为33.3%（95%CI 14.9%~51.7%）、20.0%（95%CI 2.8%~37.2%）（P=0.635）。脾肿大组5例发生慢性GVHD（广泛型3例），非脾肿大组未发生慢性GVHD（P=0.041）。④脾肿大组、非脾肿大组3年累积复发率分别为（42.7±2.6）%、（11.1±1.2）%（χ2=1.824，P=0.122），3年总生存率分别为（61.5±13.5）%、（68.6±15.1）%（χ2=0.351，P=0.554），3年无白血病生存率分别为（56.3±14.8）%、（80.0±17.9）%（χ2=1.148，P=0.284）。 结论 脾肿大可致CMML患者allo-HSCT后粒细胞植入延迟，对生存及复发无影响。

This article reported a case with primary cystic echinococcosis in the left femur.

目的 分析单倍型造血干细胞移植（haplo-HSCT）后糖皮质激素耐药急性移植物抗宿主病（GVHD）的危险因素。 方法 回顾性分析2010年1月至2011年12月在北京大学血液病研究所接受haplo-HSCT后并发急性GVHD的成人急性髓系白血病/骨髓增生异常综合征患者的临床资料。 结果 共有85例急性GVHD患者纳入研究，男55例，女30例，中位年龄30（19~67）岁。糖皮质激素治疗后达到完全缓解（CR）53例（62.4%），部分缓解（PR）6例（7.1%），未缓解（NR）26例（30.6%）。Ⅰ/Ⅱ、Ⅲ/Ⅳ度急性GVHD组糖皮质激素治疗的CR率分别为66.2%（51/77）、25.0%（2/8）（χ2=3.639，P=0.048）；累及1个、2个靶器官急性GVHD组糖皮质激素治疗的CR率分别为77.4%（48/62）、21.7%（5/23）（χ2=22.157，P

To amplify and sequenceTwenty-two post-surgical specimens of patients with hepatic alveolar echinococcosis were sampled from Qinghai Provincial People's Hospital in 2017. TheAllThe present study characterizes 6

To explore the application value of Revolution CT combining three -dimensional visualization technique in the precision resection of hepatic alveolar echinococcosis.Totally 12 patients with surgical treatment and pathologically confirmed hepatic alveolar echinococcosis in Qinghai Provincial People's Hospital were retrospectively analyzed. All the patients underwent the Revolution CT plain and enhancement scan before surgery, and the 0.625 millimeter scan data were obtained. The DICOM format data were imported into MI-3DVS for three-dimensional reconstruction, simulated cutting, volume measurement, and surgical planning.The data of 12 patients were reconstructed successfully, and the sizes and locations of the lesions as well as the hepatic vascular systems were clearly displayed. The liver volume, hydatid volume, simulated resection volume, and residual liver ratio were measured accurately. The average whole liver volume and the lesion volume of the 11 surgical treated patients were (2 429.8 ± 335.9) mL and (919.6 ± 262.8) mL respectively. The average actually removed volume was highly associated with the average simulated resection volume (Revolution CT combining three-dimensional visualization technique can achieve accurate diagnosis as well as optimal surgical planning before operation, which is of great value for the precision resection of difficult hepatic alveolar echinococcosis.

目的 观察儿童及青少年血液病患者单倍型造血干细胞移植（haplo-HSCT）后出血性膀胱炎（HC）的临床特征并探讨其影响因素。 方法 回顾性分析2015至2016年接受haplo-HSCT的89例儿童及青少年血液病患者的临床资料。 结果 全部89例患者中，≤14岁62例（儿童组）、>14~

目的 分析霉酚酸酯（MMF）预防疗程对于“北京方案”单倍体相合造血干细胞移植（haplo-HSCT）后急性移植物抗宿主病（GVHD）的影响。 方法 回顾性分析2016年9月至2017年3月在北京大学血液病研究所接受haplo-HSCT的237例标危成人（≥14岁）血液肿瘤患者，男140例（59.1%），女97例（40.9%），中位年龄30（14~60）岁。根据MMF疗程分为长疗程组（MMF 500 mg/d口服，−9 d开始，+30 d减半，+45~+60 d停药，合并CMV血症、EBV血症或迟发出血性膀胱炎者提前停用）和短疗程组（MMF 500 mg/d口服，−9 d开始，中性粒细胞植活后停药）。 结果 长疗程组（102例）、短疗程组（135例）MMF中位用药时间分别为27（7~71）、15（9~24）d。两组患者在性别、年龄、疾病类型、HLA不合位点、供受者关系、供受者血型、供者性别、供者年龄方面差异均无统计学意义。长疗程组、短疗程组Ⅱ~Ⅳ度急性GVHD发生率分别为31.1%、17.6%（P=0.018）、Ⅲ/Ⅳ度急性GVHD发生率分别为7.4%、7.8%（P=0.900）。多因素分析未发现MMF预防疗程长短对Ⅱ~Ⅳ度急性GVHD有显著影响。两组CMV血症、EBV血症、出血性膀胱炎发生率及总生存率差异均无统计学意义（P值均>0.05）。 结论 短疗程MMF预防并未增加“北京方案”haplo-HSCT患者急性GVHD发生率，对总生存亦无显著影响，可能是一种安全可行的方案。

Five patients with Fanconi anemia who received hematopoietic cell transplantation were retrospectively analyzed. The conditioning regimens included fludarabine, cyclophosphamide and anti-thymocyte globulin. Two patients received both bone marrow and peripheral blood stem cells as the source of stem cell grafts from haploidentical matched related donors, while the others received peripheral blood stem cells from unrelated donors. All patients tolerated well and reached hematopoietic reconstitution. One patient died of intracranial infection. During follow-up, 4 patients survived independent of transfusion with full donor chimerism.回顾性分析采用氟达拉滨（FLU）+环磷酰胺（CY）+抗胸腺免疫球蛋白（ATG），即FCA预处理方案，并行替代供者造血干细胞移植治疗范可尼贫血的疗效及安全性。2例采用单倍体相合骨髓联合外周血干细胞移植，3例采用非血缘供者外周血干细胞移植。患者耐受性良好，移植后均达到迅速造血重建，1例死于颅内感染，4例存活者均已脱离输血支持且保持完全供者嵌合。.

目的 探讨肺泡灌洗液（BALF）病毒检测在异基因造血干细胞移植（allo-HSCT）后常规病原学检查阴性肺炎患者诊治中的意义。 方法 回顾性分析2015年5月至2017年3月行allo-HSCT后出现肺部病变，并行支气管镜检查有完整BALF病原学检查结果的患者临床资料，比较单纯病毒检测阳性患者与所有病原学检查阴性患者的临床特点及转归。 结果 71例患者因发生肺部病变行BALF病原学检查。临床诊断单纯病毒相关性肺部病变15例（检出率为21.13%），未发现任何病原学证据患者19例，两组肺部病变中位发生时间分别为移植后176（49~1 376）d和移植后196（57~457）d（z=−0.191，P=0.864），两组患者在一般临床情况及表现上差异均无统计学意义。肺炎发病后100 d肺炎的归因死亡率分别为13.3%（2/15）和26.3%（5/19）（χ2=0.864，P=0.426），应用大剂量糖皮质激素（等效剂量≥ 250 mg/d甲泼尼龙）治疗的患者与未用激素或应用常规剂量激素组患者的死亡率分别为60.0%（6/10）和4.2%（1/24）。病毒检出组2例死亡患者均为早期应用大剂量糖皮质激素，而11例未用激素或晚期应用患者均存活。 结论 对于allo-HSCT后常规病原学检查均阴性的肺炎患者，应重视病毒感染的可能，BALF病毒检查可提高诊断率，并对治疗有指导意义。

Surgical treatment of pediatric forearm fractures is controversial. In this retrospective study, we reviewed 24 skeletally immature radial and ulnar fractures in 24 patients treated with intramedullary Rush pins and/or Kirschner wires between 1994 and 1999. The indication for surgical intervention was unacceptable closed reduction, unstable fracture pattern, open fracture, or recurrence after nonsurgical treatment. For each patient, a sugar tong splint was used for 4 weeks, and pins were removed 8 weeks after surgery. Average length of follow-up was 32 months (range, 6-58 months). All fractures in this series healed. Average time to union was 8 weeks. There were no complications of delayed union, nonunion, infection, or neurovascular injury. All patients regained full range of motion of the injured extremity.

From March 1985 to December 1991, 71 patients of aortic root aneurysm and/or aortic insufficiency underwent operative treatment. All the cases are caused by medial cystic necrosis, a predisposing degenerative change in the aorta proven pathologically. 61 Bentall's operation were done, resection of the aneurysm with dacron grafts replacement were performed in 10 cases, including 7 cases of DeBakey type III dissecting aneurysms. The mortality of previous 53 Bentall's operation was 3.77%, but in the last 8 cases (after February 1991), 2 was lost due to uncontrolled infection. So that the total operative mortality was 6.55% (4/61) in 61 Bentall operations. Some catastrophic problems and countermeasures in perioperative period, which met in this series, such as: time of operation, active bleeding and diffused blood oozing, myocardial protection and malignant arrhythmia, selection of valve prosthesis for composite grafts etc, were discussed in this paper.