Background: Myiasis is caused by dipterous larvae, and rarely affects the mouth. Diagnosis by traditional means is easy to be confused with other similar species. Here, we report a case of oral myiasis, in a 5-month-old infant who was diagnosed by morphological examination and molecular biological methods. Case presentation: A 5-month old infant with acute myeloid leukemia was admitted due to recurrent skin masses for more than 4 months. The infant had lip swelling, which prevented him from closing the mouth and membranes were present in his mouth and there were also oral ulcers and erosions. Ten maggots were found in the mouth and one in the ear canal with pus flowing out and were confirmed as the third stage larvae of Sarcophaga ruficornis by morphological examination and a comparison of sequence of cytochrome oxidase subunit 1 (COX1) gene. After removal of the maggots and chemotherapy, the infant ’s condition was gradually improved. Conclusions: To the best of our our knowledge, this is the first neonatal oral myiasis case reported in China and its diagnosis requires a high index of suspicion. Microscopy combined with specific DNA sequence analysis is an effective technological tool to provide rapid diagnoses of the larva specimen and cases of rare diseases, as illustrated in the current case.

Background and Aims: Children's coagulation system undergoes dynamic changes during development, necessitating age‐specific reference intervals (RIs). This study aimed to establish RIs for 16 coagulation parameters in Chinese children aged 0–18 years using the Sysmex CN‐6000 analyzer. Methods: We conducted a cross‐sectional study in children aged 0 day to 18 years who met the inclusion and exclusion criteria. Participants were stratified into six age groups (0–30 days, 1–6 months, 6–12 months, 1–3 years, 3–12 years, and 12–18 years) and blood samples were collected. Routine parameters (APTT, PT, PT‐INR, TT, Fibrinogen [Fib]), thrombotic markers (AT‐III, D‐Dimer [D‐Di], Fibrin Degradation Products [FDP]), and coagulation factors (II, V, VII, VIII, IX, X, XI, XII) were analyzed using the Sysmex CN‐6000 analyzer. RIs and their 90% confidence intervals (CIs) were calculated using the non‐parametric method (for n ≥ 120) or the robust method (for n < 120). Results: Neonates exhibited distinct coagulation profiles, including prolonged APTT (22.7 s–46.5 s) and TT (16.2 s–20.8 s), reduced levels of anticoagulant and coagulation factors (e.g., AT‐III: 23.1%–91.3%, factor II: 26.5%–77.5%), and elevated fibrinolytic markers (D‐Di ≤ 1.41 μg/mL; FDP ≤ 4.44 μg/mL). Age‐dependent trends were evident: APTT shortened until adolescence (24.7 s–32.9 s), while factor IX increased progressively (16.3% – 43.2% in neonates vs. 43.6%–108.6% in adolescents). Novel RIs for neonatal D‐Di and FDP were established, addressing a critical gap in developmental hemostasis. Sex‐specific differences in TT were observed but deemed clinically insignificant. Conclusion: Age‐specific RIs are essential for children. This study provides the first comprehensive RIs for Sysmex CN‐6000 in Chinese children, aiding in the diagnosis and management of coagulation disorders in pediatrics.

Objective: This study aims to elucidate the clinical features observed in cases of pediatric acute myeloid leukemia (AML) initially presenting with cardiac tamponade and to share treatment experiences.Materials and methods: Five pediatric patients were initially diagnosed with AML accompanied by cardiac myeloid sarcoma (MS). The diagnosis was established by examining our hospital records and reviewing pertinent literature from 1990 to July 2023, accessible through MEDLINE/PubMed. We comprehensively assessed the clinical characteristics and treatment modalities employed for these patients.Result: Five pediatric patients presented with acute symptoms, including shortness of breath, malaise, cough, and fever, leading to their hospitalization. Physical examination revealed irritability, hypoxia, tachypnea, tachycardia, and hypotension. Initial detection utilized chest X-ray or echocardiogram, leading to subsequent diagnoses based on pericardial effusion and/or bone marrow examination. Two patients received chemotherapy at the time of initial diagnosis, one with cytarabine and etoposide, and the other with cytarabine and cladribine. Post-treatment, their bone marrow achieved remission, and over a 2.5-year follow-up, their cardiac function remained favorable. Unfortunately, the remaining three patients succumbed within two weeks after diagnosis, either due to receiving alternative drugs or without undergoing chemotherapy.Conclusion: This is the first and largest case series of pediatric AML patients with cardiac MS, manifesting initially with cardiac tamponade. It highlights the rarity and high mortality associated with this condition. The critical factors for reducing mortality include identifying clinical manifestations, conducting thorough physical examinations, performing echocardiography promptly, initiating early and timely pericardial drainage, and avoiding cardiotoxic chemotherapy medications.

Blinatumomab has shown to improve survival outcomes in B-cell acute lymphoblastic leukemia (B-ALL) patients with measurable residual disease (MRD) detected by multiparametric flow cytometry (MFC). However, data on blinatumomab clearing MRD with high sensitivity remain scarce. This study evaluates the effectiveness of blinatumomab in eradicating low levels of MRD, as detected by droplet digital PCR (ddPCR) but undetectable by MFC, in children with B-ALL. Patients (n = 9) whose MRD was undetectable by MFC but detectable by ddPCR after chemotherapy and followed by blinatumomab consolidation were included retrospectively. After the administration of blinatumomab, 5 out of 9 patients (55.56%) successfully achieved undetectable levels of ddPCR-MRD. Notably, among the 4 patients with BCR::ABL1 gene-positive acute lymphoblastic leukemia (ALL), only one achieved gene negativity. Starting from the initiation of blinatumomab treatment, with a median follow-up of 12 months, all patients remained in complete remission. Our study was the first to demonstrate that blinatumomab could further eradicate ddPCR MRD after patients achieve MFC-MRD undetectable status in B-ALL patients.

Background: Blinatumomab could be successfully used to reduce minimal residual disease (MRD) prior to hematopoietic stem cell transplantation (HSCT) in pediatric B cell precursor acute lymphoblastic leukemia (BCP-ALL), but sound evidence is lacking in China. Case presentation: This retrospective study assessed the application of blinatumomab in B-ALL accompanied by persistent or relapsed low-level MRD before HSCT from April 2019 to July 2021. Two cases (Cases 1 and 2) initially achieved remission with MRD < 0.01% upon conventional therapy but had MRD relapse with MRD ≥ 0.01% but < 1% during maintenance treatment. Case 3 had no response to routine treatment, with high MRD (9.88% and 1.23% at days 19 and 46, respectively). Nevertheless, all patients had undetectable MRD. Cases 2 and 3 had undetectable fusion gene following blinatumomab therapy. By bone marrow monitoring (bone marrow morphology, bone marrow MRD and fusion gene) post-HSCT, the patients were persistently negative until May 15, 2022. No patient had serious adverse events before or during blinatumomab treatment. Conclusions: Blinatumomab therapy showed a good performance for three pediatric cases with detectable but low MRD before HSCT in China. However, further prospective studies with large sample sizes are still needed for further clarification.