Objective To investigate the relationship of single nucleotide polymorphism (4G/5G) in the promoter of plasminogen activator inhibitor-1 (PAI-1) and plasma PAI-1 level with gastrointestinal bleeding in Henoch-Sch?nlein purpura (HSP). Methods A total of 524 children with HSP in acute phase were recruited, and divided into gastrointestinal bleeding group (bleeding group, n?=?186) and non-gastrointestinal bleeding group (control group, n?=?338). The genotype frequency of 4G/5G polymorphism, the plasma PAI-1 level, and other parameters related to coagulation and ifbrinolysis were measured and compared between two groups. Results The levels of platelet count (PLT), platelet distribution width (PDW), serum D dimer (DD), serum PAI-1 were signiifcantly higher in the bleeding group than those in the control group, and the levels of mean platelet volume (MPV) and plasma ifbronectin protein of ifbrinogen (FIB) were signiifcantly lower in the bleeding group than those in the control group (P?

Objective To explore the role of interleukin (IL)-38 in inhibiting inflammatory bowel disease (IBD) in children and to investigate the potential molecular mechanisms.Methods From January 2014 to October 2017,67 patients with ulcerative colitis (UC) and 115 patients with Crohn's disease (CD)admitted to Wuhan Children's Hospital were recruited,and 40 individuals with normal endoscopic findings were selected as control.Serum levels of IL-38 of IBD patients and healthy control were determined by enzyme-linked immunosorbent assay (ELISA).Immunohistochemical staining (IHC) was used to detect the expression level of IL-38,nuclear factor κB (NF-κB),phosphorylated signal transduction and activator of transcription 3 (p-STAT3),C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) in the intestinal mucosa of IBD patients and healthy controls.The extent of disease,therapeutic agents and disease activity scores (Mayo score system for UC patients,Crohn's disease activity index (CDAI) for CD patients) were evaluated.IL-38-C57BL/6 transgenic mice model was established,and dextran sulfate sodium was used to induce IBD mice model.The intestinal inflammation levels were compared between the wild type IBD mice and IL-38 transgenic IBD mice.The levels of IL-38,NF-κB and p-STAT3 in intestinal mucosa of mice of different groups were determined by IHC.The ratio of CD4 + IL-17 + T helper (Th) 17 cells in peripheral blood of mice of different groups was detected by flow cytometry.Independent sample t test,chi square test and Pearson correlation were performed for statistical analysis.Results The results of ELISA showed that the serum levels of IL-38 of UC and CD patients were (6.1 ± 1.9) ng/L and (9.8 ±2.1) ng/L,respectively,which both were lower than that of healthy controls ((16.4 ± 2.7) ng/L),and the differences were statistically significant (t =23.107 and 15.853,both P ＜ 0.05).The results of IHC indicated that the levels of IL-38 in the intestinal mucosal tissues of UC and CD patients were 0.04 ± 0.01 and 0.03 ± 0.01,respectively,which were both lower than that of healthy controls (0.18 ± 0.02),and the differences were statistically significant (t =48.186 and 69.443,both P ＜ 0.05).The levels of NF-κB and p-STAT3 of UC and CD patients were 0.150 ± 0.030,0.160 ± 0.040 and 0.130 ±0.030,0.110 ±0.010,which were all higher than those of healthy controls (0.020 ±0.003 and 0.010 ± 0.002),and the differences were statistically significant (tUC =27.273 and 23.078,tCD =23.657 and 62.684;all P ＜ 0.05).The number of patients with disease at active phase,CRP level,ESR and disease activity scores of UC and CD patients with low IL-38 expression were all significantly higher than those of patients with high IL-38 expression (x2UC =11.552,tUC =7.118,8.991 and 7.086;x2CD =5.675,tCD =9.559,9.358 and 11.268;all P ＜ 0.05).The results of Pearson correlation analysis demonstrated that the level of IL-38 in the intestinal mucosal tissue of UC patients was negatively correlated with CRP,ESR and Mayo scores (r =-0.291,-0.672 and-0.639;all P ＜ 0.05).And the level of IL-38 in the intestinal mucosal tissue of CD patients was negatively correlated withCRP,ESRandCDAI (r=-0.559,-0.471 and-0.353;allP＜0.05).The IHC results showed that the levels of NF-κB and p-STAT3 of IL-38 transgenic IBD mice were lower than those of wild type IBD mice (0.14±0.02 vs.0.32 ±0.06,0.12 ±0.02 vs.0.44 ±0.07),and the differences were statistically significant (t =6.971 and 10.767,both P ＜ 0.05).The results of flow cytometry showed that the ratio of CD4 + IL.-17+ Th17 cells in the peripheral blood of IL-38 transgenic IBD mice was lower than that of wild type IBD mice (0.030±0.006 vs.0.280 ±0.050),and the difference was statistically significant (t =12.160,P ＜0.05).Conclusions The expression level of IL-38 significantly decreases in the intestinal mucosal tissues of IBD patients,while the level of NF-κB and p-STAT3 significantly increases.IL-38 may inhibit IBD by regulating NF-κB and p-STAT3 signaling pathway to alleviate intestinal immune reaction.

Objective:To compare the application effects of three different extubation techniques in patients with mechanical ventilation in intensive care unit (ICU).Methods:A prospective randomized controlled study was conducted. Mechanical ventilation patients admitted to the critical care department of the First Affiliated Hospital of Guangxi Medical University from July to November 2023 were enrolled. According to the random number table generated by Excel, the patients were divided into negative pressure group, positive pressure group 1 and positive pressure group 2, with 45 cases in each group. On the basis of routine nursing, the negative pressure group used the negative pressure extubation technique to remove the tracheal catheter. In the positive pressure group, the pressure support (PS) and positive end-expiratory pressure (PEEP) of the positive pressure group 1 were 7 cmH 2O (1 cmH 2O≈0.098 kPa) and 5 cmH 2O, and the PS and PEEP of the positive pressure group 2 were 15 cmH 2O and 10 cmH 2O. The main outcome measures were extubation related complications, including tachypnea, severe cough, sore throat, upper airway obstruction spasm, extubation failure, hypoxemia, and hypercapnia. The secondary outcome measures were the variation of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and blood oxygen saturation before and 1, 15 and 30 minutes after extubation. Results:Finally, 42 patients were included in each group. There were no significant differences in gender, age, catheter retention days, duration of mechanical ventilation, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), catheter model and diagnosis among the three groups, which were comparable. There were statistically significant differences in the incidence of tachypnea, severe cough, sore throat, upper airway obstruction spasm, hypoxemia and hypercapnia among the three groups, while there was no statistically significant difference in the failure rate of extubation. The incidence of tachypnea, severe cough, sore throat, upper airway obstruction spasm, hypoxemia and hypercapnia after extubation in positive pressure group 1 and positive pressure group 2 were lower than those in negative pressure group (7.14%, 9.52% vs. 33.33%; 7.14%, 4.76% vs. 28.57%; 61.90%, 52.38% vs. 88.10%; 11.90%, 19.05% vs. 45.24%; 7.14%, 7.14% vs. 30.95%; 4.76%, 2.38% vs. 28.57%; all P < 0.05). There were no significant differences in extubation related complications between group 1 and group 2. There were significant differences in the time effect of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and blood oxygen saturation 30 minutes after extubation among three groups ( F values were 145.792, 49.749, 22.486, 23.622 and 242.664, respectively, all P < 0.01). The intergroup effect of blood oxygen saturation was statistically significant ( F = 3.835, P = 0.024), and the blood oxygen saturation in positive pressure group 1 and positive pressure group 2 were higher than those in negative pressure group 1 minute and 30 minutes after extubation (1 minute after extubation: 0.97±0.02, 0.97±0.02 vs. 0.95±0.02; 30 minutes after extubation: 1.00±0.01, 1.00±0.01 vs. 0.99±0.02, all P < 0.05). The interaction effects of heart rate and blood oxygen saturation were statistically significant ( F values were 3.512 and 7.226, respectively, both P < 0.01). Conclusions:Compared with negative pressure extubation, positive pressure extubation can effectively reduce extubation related complications in ICU mechanically ventilated patients. It is beneficial to maintain stable blood oxygen saturation within 30 minutes after extubation, and has better clinical application effects. It is recommended to use low pressure extubation.