Hemolytic anemia is a common clinical problem with diverse etiology. 10-year-old boy presented with severe pallor. He had hemolytic facies, hepatosplenomegaly & deformity of small joints. Investigations revealed DAT-ve anemia, reticulocytosis and low haptoglobin. BM showed erythroid hyperplasia. Past history revealed recurrent fever, rash, hepatosplenomegaly, lymphadenopathy and poly arthritis diagnosed as systemic-JIA and MAS necessitating admission twice. Hence, a diagnosis of hemolytic anemia with auto inflammatory disease was considered. Whole Exome revealed compound heterozygous mutation in CECR1 gene. DADA2 is a syndrome with varied manifestations including vasculitis, hematological and immunological abnormalities. Clue in our patient was presence of periodic fever.

Feline parvovirus (FPV) is a member of the Parvoviridae family, which is a major enteric pathogen of cats worldwide. This study aimed to investigate the prevalence of feline parvovirus in Beijing, China and analyze the genetic features of detected viruses. In this study, a total of 60 parvovirus-positive samples (8.5%) were detected from 702 cat fecal samples using parvovirus specific PCR. The complete VP2 genes were amplified from all these samples. Among them, 55 sequences were characterized as FPV (91.7%), the other five were typed as canine parvovirus type 2 (CPV-2) variants (8.3%), comprised of four CPV-2c and a new CPV-2b strain. In order to identify the origin of CPV-2 variants in cats, we amplified full-length VP2 genes from 7 fecal samples of dogs infected with CPV-2, which were further classified as CPV-2c. Moreover, the sequences of new CPV-2b/MT270586 and CPV-2c/MT270587 detected from feline samples shared 100% identity with previous canine isolates KT156833 and MF467242 respectively, indicating the CPV-2 variants circulating in cats were derived from dogs. Sequence analysis indicated new mutations, Ala91Ser and Ser192Phe, in the FPV sequences, while obtained CPV-2c carried mutations reported in Asian CPV variants, showing they share a common evolutionary pattern with the Asian 2c strains. Interestingly, the FPV sequence (MT270571), displaying four CPV-specific residues, was found to be a putative recombinant sequence between CPV-2c and FPV. Phylogenetic analysis of the VP2 gene showed that amino acid and nucleotide mutations promoted the evolution of different geographical branches of FPV and CPV lineages. Our findings will be helpful to further understand the circulation and evolution of canine and feline parvovirus in Beijing.

In order to explore the relationship between morphological traits and body weight of Pteria penguin from the Meiji Reef, it was expected to provide technical support for the breeding of excellent traits. Pteria penguin from Meiji Reef was randomly selected, their body weight (Y) and 10 (X1-X10) morphological traits were obtained through measurement, and the study was carried out around the mutual influence of their morphological traits to body weight. The results showed that there was a positive correlation between the body weight of Pteria penguin and various morphological traits, and the correlation coefficients reached a very significant level (P<0.01). Path analysis found that the length from top to back ear base (X8) had the greatest direct effect on body weight (0.576), followed by shell height, shell width. Coefficient of determination analysis showed that the sum of the co-determination coefficients of these three traits to body weight was 0.811, which further indicated that body weight was mainly affected by the above traits. After multiple regression analysis, the regression equation of Pteria penguin morphology and body weight was established, and the best fitting curve model was screened out. In actual production operations, when breeding Pteria penguin with body weight as the target parent, the length from top to back ear base (X8) should be used as the main trait reference, and the shell height (X2) and shell width (X3) should be used as the auxiliary trait reference.

Spherical crystallization is a promising process intensification technique, where surfactant is an important ingredient in formulation but needs to be used carefully due to toxicological reasons. This work proposes to substitute the conventionally used surfactants by adopting colloidal particles stabilized Pickering emulsions for spherical crystallization. A representative system is selected for study, where silica nanoparticles are prepared to stabilize emulsions and evaporative crystallization of ibuprofen is carried out. Depletion attraction is exploited to improve the Pickering emulsion stability for better confining on crystallization with two depletants PEG and PVA tested. Crystal products from the emulsions prepared with silica nanoparticles and the non-ionic surfactant Tween 20 are compared. The results show that depletion attraction is helpful for producing stable Pickering emulsions with high dispersed phase fraction and mono-dispersed ibuprofen spherical agglomerates. Silica nanoparticles contribute to reduced induction time by boosting heterogeneous nucleation and mitigate secondary agglomeration possibly by steric effects.

In this paper, tangent, principal normal and binormal wise associated curves are defined such that each of these vectors of any given curve lies on the osculating, normal and rectifying plane of its mate, respectively. For each associated curves a new moving frame and the corresponding curvatures are found, and in addition to this the possible solutions for distance functions between the curve and its associated mate are discussed. In particular, it is seen that the involute curves belong to the family of tangent associated curves, the Bertrand and the Mannheim curves belong to the principal normal associated curves. Finally, as an application, we present some examples and map a given curve together with its mate and their frames.

We examine the main results concerning the existence and structure of travelling waves (TWs) which may occur in the following equation namely, u_t+uu_x=u_xx+u(1-u)(u-m),-∞0, where ≠ 0, represents distance, represents time and > 2 is a constant. We use dynamical system theory to obtain the results of the equation and exhibit a phase-space of their stable points. As a beginning we start to get ordinary differential equation form of above equation after substituting of a new transformation into it. Additionally, all points are indicated depending on the structure of eigenvalues of the critical points in phase-space by using a generated matlab implementation of ode45 package. Our goal is to find a heteroclinic trajectory from unstable node to stable node in parallel with travelling wave solutions for the minimum waving accelerate and the structure of the other soliton solutions to be defined. Furthermore the good agreement of the convergence of exact solution of above equation and numerical solution of dynamic system of the equation found by applying parabolic method, is demonstrated. The results of our study demonstrate that the equation given above can confirm soliton solutions.

Abstract Objective: The aim of this study was to identify the role of nasal Staphylococcus aureus (S. aureus) colonization and the effect of systemic or local antibiotic treatment on disease activity in patients with antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis and ear, nose and throat (ENT) involvement. Methods: Clinical, laboratory and histological data from all patients with ANCA-associated vasculitis and ENT involvement, who were diagnosed in two medical centres in the Netherlands between 1981 and 2020, were retrospectively collected. Nasal S. aureus colonization was defined as at least one positive nasal swab during follow-up. Data on systemic (cotrimoxazole and azithromycin) and local (mupirocin) antibiotic use was collected. Disease activity was divided into systemic and local disease activity. Results: Two-hundred and thirteen patients were available for analysis. Median follow-up time was 8 (IQR 3 -17) years. S. aureus colonization was tested in 100 (46.9%) cases of whom 44 patients (44%) tested positive. In these 100 patients, systemic and local disease activity at baseline and at last visit were comparable between patients with and without and S. aureus colonization. Twenty-eight of the 44 S. aureus positive patients received antibiotics aimed at eradication of S. aureus. No statistically significant difference was found between the treated versus non-treated group with regard to systemic and local disease activity. Conclusion: Nasal S. Aureus colonization does not influence systemic or local disease activity. Antibiotic treatment aimed at eradication did not modify disease activity.

Different extrinsic factors (environmental conditions) significantly impact industrial fermentation processes due to direct effects on yeast performance and morphology. In this study, the effect of extrinsic factors including Free Amino Nitrogen (FAN) concentration, total pressure, and temperature, on the fermentation attributes, yeast morphology, and volatile organic compounds (VOCs) production was assessed. Fermentation attributes including yeast growth, viability, and ethanol production were monitored, yeast morphology was assessed using automated image analysis, and VOCs were quantified using gas chromatography. High FAN fermentations resulted in more yeast in suspension and high viability, faster fermentation rate, larger yeast cross-sectional area (CSA), and more VOCs production compared to low FAN concentrations. Low CO2 pressure (vacuum pressure) resulted in more cells in suspension and high viability, more ethanol production, smaller yeast CSA, and larger vacuolar space in comparison to high (atmospheric) CO2 pressure. Low temperatures fermentations resulted in more cells in suspension and high viability, more ethanol production, smaller yeast CSA, and more VOC production compared to high temperature fermentations. These results can be used to optimize industrial fermentation processes based on the novel understanding of the extrinsic factors studied, especially low (vacuum) CO2 pressure during fermentation.

The evolution of parasites is often directly affected by the host’s environment or behavior. Studies on the evolution of the same parasites in different hosts are extremely attractive and highly relevant to our understanding of divergence and speciation. Here we analyzed the genetic variation of Equus roundworm populations in different hosts (horses, zebras and donkeys), and presented the first molecular evidence of divergence in Equus roundworms (Parascaris univalens). At the genetic level, Equus roundworms were mainly separated into two clades (Horse-derived and Zebra & Donkey-derived). This divergence began at 600-1500 years ago, which interestingly coincided with the domestication history of horses. We found that compared with horse-derived roundworms, most of the key enzymes related to glycolysis were under strong positive selection in zebra & donkey-derived roundworms, indicating that the evolution of the metabolic level was one of the main reasons for the divergence. In addition, we conducted a selective scan of resistance-related genes and found that the three populations were under different degrees of selection. This prompted us to pay attention to the possible impact of drugs on divergence, not just the drug resistance. This work supports that divergence or speciation is a continuous and dynamic process, and continuous monitoring of environmental factors is conducive to further understanding the adaptive evolution of roundworms.

Objective: Analyze ECV results when propofol is used for sedation. Design: Longitudinal prospective analysis Setting: 1st of January of 2018 and 31st of December of 2020. Population: Pregnant women with non-cephalic presentation and no contraindication for vaginal delivery. Methods: Longitudinal prospective analysis of ECV performed in a tertiary hospital between the Just before the procedure, 0.2 mg/min of ritodrine was intravenously administered for 30 minutes. Sedation or neuraxial anesthesia was performed before the ECV. Main Outcome Measures: ECV success rate, Hypotension during procedure, ECV complication rate, cesarean section 24 h after ECV. Results: 242 pregnant women underwent ECV. All data were available for analysis just in 153 cases. ECV success rate was 66.9%. Sedation was performed in 88.8% and neuraxial anesthesia was carried out in 11.2%. For the sedation group, propofol was used in 96.3%. Emergency cesarean section rate during the following 24 hours of ECV was 6.7%. No difference in the emergent cesarean section during the 24 hours following the ECV rate when sedation or neuraxial anesthesia were performed (p=0.53). Conclusions: ECV is a safe and effective procedure. Sedation with propofol is useful for analgesia in ECV. Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

Case presentation In this case, we are presenting 26-year-old young patients, who took 60-gram metformin plus 900 mg pioglitazone, presenting with abdominal pain, nausea, confusion, and lethargy. And lactic acidosis was treated with continuous hemodialysis >15 hours. Our aim, in this case, is to highlight the importance of continuous hemodialysis in the treatment of metformin poisoning. Discussion Metformin is an oral antidiabetic drug which is used as a first line treatment in the treatment of DM. Metformin poisoning is a rare condition seen by clinicians. One of the severe side effects of metformin poisoning is lactic acidosis and it can be fatal without on-time treatment due to acidosis-related complications. Conclusion Metformin toxication is a rare condition seen in clinical practice. Metformin associated lactic acidosis is one of the expected complication. The continous dialysis can be effective to treat the lactic acidosis caused by metformin toxication. What’s already known about this topic? Lactic acidosis might be caused by metformin toxicity. Without on-time treatment for metformin toxicity, it can cause life-threatening condition. What does this article add? The treatment of hemodialysis, especially continous hemodialysis, might be beneficial to treat the patients with metformin toxicity. Key words: Metformin Toxicity, Dialysis, Lactic acidosis

Immunoglobulin E (IgE) is a key mediator for the immune reaction in airway mucosa and plays a vital role in nasal polyposis(NP). We review the most recent evidence for the local IgE’s characteristics, the modulation of its synthesis and function in NPs. The level of local IgE is significantly elevated in polyps independently of IgE serum levels and atopic status. Furthermore, local IgE is polyclonal and functional, which is correlated with type 2 inflammation. IgE is produced by active B cell and dependent on the classing switch recombination(CSR). In NPs, this process is triggered by not only allergens but also microbial colonization, especially the superantigen- Staphylococcus aureus. The production of local IgE is modulated by lymphocytes, cytokines, transcription factors and B cell intrinsic factor. Due to the central role of IgE in NPs, it is regarded as an ideal target for therapy and has been proved to be clinically successful. Based on this knowledge, we believe that exploring the trigger and regulatory factors for the activation of local B cells and CSR to IgE will provide more valuable information for us to recognize the pathological mechanisms of local IgE and offer the possible option for new therapeutic targets of NPs.

Background and Purpose: The human TE671 cell line was originally used as a model of medulloblastoma but has since been reassigned as rhabdomyosarcoma. Despite the characterised endogenous expression of voltage-sensitive sodium currents in these cells, the specific voltage-gated sodium channel (VGSC) subtype underlying these currents remains unknown. Experimental Approach: To profile the VGSC subtype in undifferentiated TE671 cells, endpoint and quantitative reverse transcription-PCR and whole-cell patch clamp electrophysiology were performed. Key Results: qRT-PCR profiling revealed that expression of the SCN9A gene was 215-fold greater than the SCN4A gene and over 400-fold greater than any of the other VGSC genes. Elicited sodium currents had a mean amplitude of 2.6 ± 0.7 nA with activation and fast inactivation V50s of −31.9 ± 1.1 mV and −69.6 ± 1.0 mV respectively. The currents were completely and reversibly blocked by tetrodotoxin at concentrations greater than 100 nM (IC50 = 22.3 nM). They were also very susceptible to the NaV1.7 specific blockers Huwentoxin-IV and Protoxin-II with IC50 values of 14.6 nM and 0.8 nM respectively, characteristic of those previously determined for NaV1.7. Conclusion and Implications: Combined, the results from molecular, electrophysiological and pharmacological profiling revealed the non-canonical and highly dominant expression of NaV1.7 in the human TE671 rhabdomyosarcoma cell line. We show that the TE671 cell line is an easy to maintain and cost effective model for the study of NaV1.7 that has become a major target for the development of analgesic drugs and more generally for the study of pain.

A case of postural urticaria in a 14-year-old girlSofianne Gabrielli, MSc1, Michelle Le, MD2, Elena Netchiporouk, MD, MSc2, Moshe Ben-Shoshan, MD, MSc11Division of Allergy, Immunology and Dermatology, Montreal Children’s Hospital, Montreal,QC, Canada.2Division of Dermatology, McGill University, Montreal, QC, Canada.Keywords: urticaria, postural urticaria, antihistamines, omalizumabTo the Editor,Chronic urticaria (CU) is defined by the presence of wheals and/or angioedema for more than six weeks1. CU is classified as spontaneous (CSU) or inducible (CIndU) urticaria, based on the ability to identify a trigger1. CIndU, which can be classified into physical and non-physical forms, is less common than CSU and can be diagnosed by provocation test. We describe the case of a 14-year-old female patient with postural urticaria induced by changing from a seating to standing position. To our knowledge, there is only one other case of postural urticaria described in a teenage boy2.A 14-year-old female patient presented with a two-year history of intermittent hives on her bilateral legs which developed 20 minutes after standing. The patient also described symptoms of tingling in her legs prior to the development of the hives. The symptoms usually resolved after a few hours. In addition, the patient reported spontaneous hives almost daily not related to an identifiable trigger. The patient was otherwise healthy and was not taking any medication. The patient’s father reported a history of urticaria in childhood which resolved, although he still rarely experiences episodes of hives.Upon examination, the patient developed prominent vasculature (livedo reticularis) and urticaria on her bilateral legs 20 minutes after changing from a seated to a standing position (Figure 1A and 1B). When seated, the patient’s blood pressure was 113/77 and her heart rate was 102. Upon standing, the patient’s blood pressure was 101/82 and her heart rate was 118. All laboratory tests, which included a complete blood count, thyroid stimulating hormone, anti-thyroid peroxidase Immunoglobulin (Ig) G, tryptase, and total IgE, were within the normal limits. The patient’s weekly Urticaria Activity Score (UAS7) in the week prior to exam was 9.Given poor response to standard doses of second-generation anti-histamines, the patient was treated with bilastine 40 mg twice daily. After one year, due to poor response to treatment, the patient was placed on 300 mg of omalizumab administered once per month. Over the period of one year, the patient did experience improvement in her spontaneous urticaria symptoms, with her UAS7 decreasing from 38 to 9 over a period of two years. However, there was no improvement in the symptoms related to change in posture.The mechanism of action of postural urticaria in this patient is unknown. It was previously hypothesized that change in venous pressure or blood flow volume from sitting to standing may induce the release of mediators such as acetylcholine that may induce hive development2.The management of postural urticaria in our patient was not clear as she did not improve with antihistamines, nor with the addition of omalizumab treatment. It possible that the patient may gain better control of her hives with other management strategies, such as a higher dose of omalizumab3 or a different biologic, such as ligelizumab4. Clinicians should be made aware of this presentation of postural urticaria given that it may reflect a more recalcitrant form of CIndU. We suggest that a provocation test consisting of standing for 10 to 20 minutes should be used to confirm the diagnosis of postural urticaria.

Introduction: In this study, we aimed to investigate cardiac involvement in patients diagnosed with the new Coronavirus Disease 2019 (COVID-19). Materials and Methods: Patients diagnosed with COVID-19 pneumonia in the emergency department were included in this retrospective study. Patients diagnosed with COVID-19 pneumonia were included in Group 1 and healthy individuals (as control group) were included in Group 2.CCT images were transferred to the Intrasense Myrian® software. Total cardiac volume (TCV) was measured in three-dimensional images. Obtained parameters were compared between groups Results: Total cardiac volume was 525.35±29.96 cm3 (min:244cm3 - max:1545cm3) in Group 1 and 369.64±10.41cm3 (min:229cm3 - max:522cm3) in Group 2 (P=0.000). In Group 1 patients, levels of D-dimer, C-reactive protein (CRP) and high sensitivity troponin I (hs-TnI) were 391.00 (6.00-6450) µg/L, 3.50 (0.10-30.40) mg/dL and 4.41 (1.00-3627.00) ng/mL, respectively, whereas those in Group 2 were 112.50 (3.00-767.00) µg/L, 0.20 (0.10-19.30) mg/dL and 2.50 (2.30-36.02) ng/mL, respectively (P<0.05). Conclusion: Total cardiac volume increases in patients that develop pneumonia due to COVID-19 infection. D-dimer, CRP and hs-TnI levels also increase with TCV. Keywords: COVID-19, chest computed tomography, total cardiac volume, C-reactive protein, D-dimer, high sensitive troponin I

In this paper, by using the concentration–compactness principle of Lions for variable exponents found in \cite{Bonder} and the Mountain Pass Theorem without the Palais-Smale condition given in \cite{Rabinowitz}, we obtain the existence and multiplicity solutions $ u=(u_1,u_2,….u_n)$, for a class of Kirchhoff-Type Potential Systems with critical exponent, namely \begin{eqnarray*} \begin{cases} -M_i\Big(\mathcal{A}_i(u_i)\Big) \textrm{div}\,\Big( \mathcal{B}_i(\nabla u_i)\Big)=|u_i|^{s_i (x)-2}u_i +\lambda F_{u_i}(x,u) & \text{in }\Omega, \\ u=0 & \text{on }\partial\Omega; \end{cases} \end{eqnarray*} \\ where $\Omega$ is a bounded smooth domain in $\mathbb{R}^N (N\geq 2)$, and $$\mathcal{B}_i(\nabla u_i)=a_i\Big(|\nabla u_i|^{p_i(x)}\Big) |\nabla u_i|^{p_i(x)-2} \nabla u_i . $$ The functions $M_i$, $ \mathcal{A}_i$, $a_i$ and $a_i$, ($1\leq i \leq n$), are given functions, whose properties will be introduced hereafter, $\lambda$ is positive parameter, and the real function $F$ belongs to $C^1(\Omega \times \mathbb{R}^{n})$, $F_{u_i}$ denotes the partial derivative of $F$ with respect to $u_i$. Our result extend, complement and complete in several ways some of many works in particular \cite{chems1}. We want to emphasize that a difference of some previous research is that the conditions on $a_i(.)$ are general enough to incorporate some differential operators of great interest. In particular, we can cover a general class of nonlocal operators for $p_i(x)>1$ for all $x\in \overline{\Omega}$.

Article category: Letters to the editor

In this study, definitions of multiplicative Taylor series (MTS), multiplicative Taylor polynomials (MTP) and multiplicative power series(MPS) are given. Solutions of first and second order multiplicative linear differential equations (MLDE) are investigated with the help of the MPS. In addition, the solution of the n’th order multiplicative linear differential equation via MPS is generalized. These studies are supported with numerical examples.

In this paper, the solvability for the fractional boundary value problem system. The fixed point theorem is used to prove that there are three positive solutions for problems.

We study a class of nonlinear periodic systems driven by general differential operators with variable exponent. We assume that the reactions contains p(x)-growth nonlinearities with respect to the gradients. By using Leray Schauder’s topological degree combined with the sub- and super-solutions method, we establish the existence and uniqueness results of weak periodic solutions to the studied systems.

In this paper, we consider an abstract system which consists of a hemivariational inequality of parabolic type combined with a nonlinear differential inclusion (DPHVI, for short) in the framework of Banach spaces. The objective of this paper is fourfold. The first one is to deal with the existence of solutions and the properties of the solution set for parabolic hemivariational inequalities (PHVIs, for short). The second aim is to investigate the existence of mild solutions for DPHVI by means of a fixed point technique. The third target is to study the existence of a global attractor for the $m$-semiflow governed by DPHVI. Finally, the fourth goal is to illustrate an application of our abstract results.

This paper mainly studies the problem of solving a class of first-order nonlinear non-homogeneous ordinary differential equations with variable coefficients， which can be transformed into solvable second-order linear homogeneous variable coefficient ordinary differential equations using elastic transformation. Firstly, the paper uses elastic transformation to upgrade a class of first-order nonlinear non-homogeneous variable coefficient ordinary differential equations to second-order linear homogeneous variable coefficient ordinary differential equations, and then the general solution expression of this first-order differential equation is obtained by using the general solution of the second-order linear homogeneous ordinary differential equation with variable coefficients, elastic transformation and related operation rules. Secondly, according to the solving process of first-order nonlinear non-homogeneous ordinary differential equations with variable coefficients, the steps for solving such differential equations are summarized. Finally, examples are given to prove that it is effective, simple and feasible to solve the first-order nonlinear non-homogeneous ordinary differential equation with variable coefficients by elastic transformation. The research in this paper provides a new idea for solving a class of first-order nonlinear non-homogeneous ordinary differential equations with variable coefficients.

Background: Late effects in childhood cancer survivors are a major cause of morbidity and mortality. The objective was to establish knowledge about the disease, late effects, self-care practices, application of health knowledge/education, sources of information, and biopsychosocial impact of cancer, and compare the results of Chile and Croatia. Procedure: one hundred and seventy-one, five-year survivors who were treated for leukemia or non-Hodgkins lymphoma responded to a questionnaire (119 in Chile and 52 in Croatia). The instrument was reviewed by BFM- ELTEC. Results: health knowledge about past diagnosis and general treatment had 96% Chilean and 85% Croatian survivors. Ninety percent of Chilean and 73% of Croatian survivors were unaware of possible late effects, and half did not know which specialist to visit for follow-up. Forty-six percent of Chilean and 35% of Croatian survivors knew about healthy lifestyles, but most did not practice them. Health education was received during the treatment in 74% Chilean and 87% Croatian survivors. About 50% survivors in both groups had experienced fear or anguish, but it was also considered an experience to grow for 60% of Chilean and 42% Croatian survivors. Eighty-seven percent Chilean and 77% Croatian survivors considered themselves physically independent, while 76% and 75% felt psychologically independent, respectively. Conclusion: It was detected a significant lack of knowledge about the specific treatment, late effects, and future health in both countries. They did not achieve significant learning with the education received. Psychological sequelae were found that are important to prevent.

Objective: To assess the clinical features and the management of skin flap infection (SFI) following cochlear implantation (CI) and to characterize the biofilm features by the scanning electron microscopy.Setting: The study was conducted at a tertiary care center.Participants: A total of 1,251 patients receiving CI in the First Affiliated Hospital of Fujian Medical University between August 2001 and March 2021 were enrolled. Scanning electron microscopy was utilized for characterizing the etiology of infection. Main outcome measures: A proposed stratification system was applied to optimize treatments for post-operation flap infection.Results: After CI, SFI was reported in 16 patients (1.28%) and patients under 18-year-old were more prone to flap infection. Staphylococcus Aureus was found to be the most common bacterial culprit for flap infection, with 6 cases explored in this group (6/16, 37.5%). Bacterial biofilm was observed within the jelly-like substance on the surface of CI equipment of SFI patients. A two-stage stratification was proposed for optimizing the treatment schemes. Conservative therapy was recommended for stage I cases while surgical treatment was the preferred method for stage II patients.Conclusions: Pediatric patients are more susceptible to SFI after CI. The formation of bacterial biofilm may be the vital cause of SFI. The proposed stratification can facilitate the management of SFI.