Cushing′s syndrome refers to a group of disorders caused by excessive secretion of adrenal glucocorticoid due to various underlying etiologies. Among these, ACTH-dependent Cushing′s syndrome, in which the source of ACTH-secretion remains unclear for extended periods, poses significant challenges in clinical management. This article presents a patient with ACTH-dependent Cushing′s syndrome where the ACTH-secreting source could not be definitively localized from our hospital. Additionally, the article reviews recent advancements in the diagnosis and treatment of such cases, both domestically and internationally, with the aim of enhancing clinicians′ understanding and improving the management of this condition.

[Objective]To develop a classification model based on complete blood count(CBC)parameters combined with clinical factors to predict severe respiratory infections caused by Human adenovirus(HAdV)in pediatric patients.[Methods]From September 2023 to September 2024,the CBC parameters and related clinical data from pediatric patients diagnosed with HAdV infection were collected.Principal component analysis and random forest models were used to identify potential predictors of severe cases.[Results]A total of 668 pediatric patients were included,with 564 cases assigned to the training cohort and 104 cases to the validation cohort.Severe cases were defined as pneumonia and/or fever lasting≥5 days(pneumonia or prolonged fever,PorPF).Principal component analysis and feature importance analysis(Mean Decrease Gini value)identified the monocytosis ratio(PMono),red blood cell count(RBC),and platelet count(PLT)as the most critical CBC parameters.Logistic regression analysis revealed that oxygen therapy(OR=4.367,95%CI:1.568-12.161)and increased work of breathing(OR=3.904,95%CI:2.146-7.101)were relative risk factors for PorPF.Meanwhile,higher PMono(OR=0.696,95%CI:0.640-0.757),RBC(OR=0.201,95%CI:0.124-0.325),and PLT(OR=0.990,95%CI:0.987-0.994)were protective factors.When PMono was used as a predictive marker for PorPF,the area under the receiver operating characteristic curve(AUC)was 0.648 and 0.705,respectively.A random forest model incorporating four risk factors[PMono,RBC,PLT,and hematocrit(HCT)]was constructed to classify PorPF and general cases,achieving AUCs of 0.688 and 0.768,respectively.[Conclusions]PMono,RBC,and PLT may serve as characteristic CBC indicators for predicting pneumonia or prolonged fever in children with HAdV infection.A risk factor model built using PMono,RBC,PLT,and HCT offers a relatively simple and accurate approach to predicting severe cases in pediatric HAdV infections.

Objective:To investigate the impact of immunosuppressive therapy on the severity of SARS-CoV-2 infection and cytokine levels in pediatric patients with kidney diseases.Methods:A retrospective analysis was conducted on the clinical data of 40 hospitalized pediatric patients who were diagnosed with SARS-CoV-2 infection at the 900th Hospital of PLA Joint Logistic Support Force from December 2022 to February 2023. Based on their immunosuppressive status prior to SARS-CoV-2 infection, these patients were categorized into immunosuppressive group and non-immunosuppressive group. Independent sample t-tests, Mann-Whitney U tests, and χ2 test were employed to compare the clinical baseline characteristics and laboratory data, the severity of SARS-CoV-2 infection, and the levels of cytokines between the 2 groups. Results:Among the 40 patients, 11 were in the immunosuppressive group (aged 13 (8, 14) years, 9 males and 2 females) and 29 in the non-immunosuppressive group (aged 2 (1, 4) years, 15 males and 14 females). In the immunosuppressive group, 2 were asymptomatic cases, 8 were mild cases, and 1 was moderate case, and there was no severe or critical cases. In the non-immunosuppressive group, 8 were mild cases, 5 were moderate, 15 were severe cases, 1 was critical case, and no asymptomatic cases. The underlying diseases in the immunosuppressive group included nephrotic syndrome (6 cases), IgA vasculitis nephritis (2 cases), lupus nephritis (1 case), post-renal transplantation (1 case), and renal failure (1 case), with a mean total immunosuppression score (TIS) of (3.6±1.4) points. In the non-immunosuppressive group, 2 patients had a history of epilepsy, and the remaining 27 cases had no underlying conditions, all with TIS scores of 0. Compared to the children in the non-immunosuppressive group, those in the immunosuppressive group were more likely to exhibit asymptomatic or mild infection, with lower risks of severe disease, cytokine storm, fever, and cough, but a higher risk of fatigue ( OR=1.22, 2.66, 0.48, 0.12, 0.12, 0.13, 1.22; 95% CI 0.93-1.62, 0.99-7.15, 0.33-0.70, 0.03-0.57, 0.03-0.57, 0.03-0.65, 0.93-1.62; all P<0.05). The levels of cytokine IL-6, interferon-α and interferon-γ in the immunosuppressive group were all lower than those in the non-immunosuppressive group ( Z=2.23, 2.51, 2.92, respectively; all P<0.05). Conclusion:Pediatric patients with kidney diseases receiving appropriate immunosuppressive therapy may mitigate the severity of SARS-CoV-2 infection by suppressing the expression of cytokines.

Objective:To develop a quality control model for anal sphincter ultrasound images and validate its diagnostic performance across multiple centers.Methods:A retrospective analysis was conducted on anal sphincter ultrasound images from seven medical centers in China between May 2019 and June 2022. A total of 7 040 images from 3 116 patients were included and divided into a training set（4 912 images）and a validation set（2 128 images）. The images were classified as standard or non-standard images by three experts. Three models were developed based on different image feature extraction methods：a single-branch model，a multi-branch weighted model，and a multi-branch ensemble model. The diagnostic performance of each model was evaluated using the area under the ROC curve（AUC），sensitivity，specificity，accuracy，positive predictive value，and negative predictive value，respectively. The optimal model was selected and compared with the performance of 4 doctors with varying experience levels. Sixty days later，the images with the assistance of the model's output were reassessed by the doctors to evaluate its impact on manual quality control.Results:① Among the 3 models，the multi-branch ensemble model demonstrated the highest AUC and sensitivity，with an AUC of 0.966（95% CI=0.958 - 0.974），a sensitivity of 91.83%，and a specificity of 91.41%. This model was named M quality. ② M quality's AUC was slightly lower than that of Senior A and B（0.966 vs. 0.976，0.976，and P<0.05），its sensitivity was slightly lower than that of Senior A（91.83% vs. 95.61%， P<0.001）but comparable to Senior B（91.83% vs. 92.89%， P=0.315），its specificity was slightly lower than Senior A and B（91.41% vs. 94.44%，98.18%，and P<0.05）. However，M quality significantly outperformed Junior A and B in AUC and sensitivity（AUC：0.966 vs. 0.850，0.818；sensitivity：91.83% vs. 84.90%，61.46%；all P<0.001），its specificity was higher than that of Junior A（91.41% vs. 80.28%， P<0.001）but lower than that of Junior B（91.41% vs. 95.96%， P<0.001）. ③ With model assistance，Senior B's sensitivity（92.89% vs. 94.20%， P=0.001）and Senior A's specificity（94.44% vs. 96.56%， P<0.001）improved significantly. Junior A and B showed significant improvements in AUC and sensitivity（AUC：0.931 vs. 0.850，0.914 vs. 0.818；sensitivity：91.83% vs. 84.90%，89.53% vs. 61.46%；all P<0.001）. After model assistance，Junior A's specificity increased（93.62% vs. 80.28%， P<0.001），while Junior B's specificity decreased（91.60% vs. 95.96%， P=0.013）. Conclusions:This study develops a quality control model for anal sphincter ultrasound images with robust diagnostic performance，approaching the level of seniors. The model significantly enhances the image quality assessment capabilities of juniors，demonstrating promising clinical application potential.

Objective:To analyze the research and development of control system for airbag pressure of intelligent tracheal catheter,and its application effect in clinical practice.Methods:The hospital designed an intelligent self-adaptive control system for cuff pressure of tracheal catheter,which can rationally apply main components such as single chip microcomputer,display screen,control panel,pressure monitoring module,inflation device and solenoid valve,etc..This control system connected the measuring module of pressure through single chip microcomputer,so as to continuously detect the airbag pressure of tracheal catheter.An inflation and deflation algorithm was independently researched and developed to control air pump or solenoid valve to inject or release part of the gas to the airbag,so as to achieve intelligent control for the pressure of airbag.Sixty patients underwent endotracheal intubation who admitted to the department of general surgery of Wuhan Hospital of Traditional Chinese Medicine from January 2022 to January 2023 were selected as the study objects,and they were divided into control group(n=30)and observation group(n=30)according to random number table method.The cuff pressure of endotracheal intubation of patients in control group were managed by conventional method.The intelligent adaptive control system was adopted to manage the cuff pressure of endotracheal intubation for patients in the observation group.The complications,compliance rate of airbag pressure,the instantaneous maximum value of airbag pressure during sputum aspiration,insertion of gastric tube,and turning over of body were compared between the two groups after intubation.Results:The incidence of complication included cough,trachyphonia,dysphagia and bloody sputum after tracheal intubation in the observation group were 6.66%,which was significantly lower than 33.33%in the control group,and the difference was statistically significant(x2=6.667,P<0.05).The compliance rate of the pressure(25-30cmH2O)of airbag in the control group was 92.83%,which was significantly lower than 97.78%in the observation group,and the difference was statistically significant(x2=14.698,P<0.05).The instantaneous maximum values of airbag pressure during sputum aspiration,insertion of gastric tube and turning over were(28.24±3.65)cmH2O,(27.98±4.25)cmH2O and(28.65±4.87)cmH2O in observation group,respectively,which were significantly lower than those in control group,and the differences were significant(t=17.930,19.208,16.485,P<0.05).Conclusion:The application of intelligent adaptive control system for cuff pressure of tracheal catheter can maintain the airbag pressure of tracheal catheter at normal level(20-30 cmH2O),and reduce complications,and improve the compliance rate of airbag pressure.

Objective:To explore the predictive value of miR-21 combined with high mobility group box-1 protein (HMGB1) for postoperative prognosis in patients with hypertensive intracerebral hemorrhage (HICH).Methods:A total of 137 HICH patients (HICH group) admitted to the Central Hospital of Yongzhou from March 2021 to March 2023 were retrospectively selected, and 60 healthy subjects undergoing physical examination in the same hospital during the same period were enrolled as the control group. Serum miR-21 and HMGB1 levels were compared between the two groups, and differences in serum miR-21 and HMGB1 levels among HICH patients with different disease severities and prognoses were analyzed. Univariate and multivariate logistic regression analyses were used to screen influencing factors for postoperative prognosis in HICH patients, and receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of miR-21 combined with HMGB1 for postoperative prognosis.Results:The relative expression level of serum miR-21 on postoperative day 1 in the HICH group was significantly lower than that in the control group ( P<0.05), while the HMGB1 level was significantly higher ( P<0.05). With the aggravation of HICH severity, the relative expression of serum miR-21 significantly decreased (all P<0.05), while the HMGB1 level significantly increased (all P<0.05). The relative expression of serum miR-21 in the good prognosis group was significantly higher than that in the poor prognosis group ( P<0.05), while the HMGB1 level was significantly lower ( P<0.05). Univariate and multivariate logistic regression analyses showed that miR-21, HMGB1, preoperative Glasgow Coma Scale (GCS) score, and preoperative hematoma volume were influencing factors for postoperative prognosis in HICH patients (all P<0.05). ROC curve showed that the areas under the curve (AUC) of miR-21 and HMGB1 for predicting poor postoperative prognosis in HICH patients were 0.925 and 0.913, respectively, while the AUC of miR-21 combined with HMGB1 was 0.950. Conclusions:Peripheral blood miR-21 is significantly decreased and HMGB1 level is significantly increased in HICH patients. miR-21 combined with HMGB1 has a good predictive value for poor postoperative prognosis in patients with hypertensive intracerebral hemorrhage.

Cushing′s syndrome refers to a group of disorders caused by excessive secretion of adrenal glucocorticoid due to various underlying etiologies. Among these, ACTH-dependent Cushing′s syndrome, in which the source of ACTH-secretion remains unclear for extended periods, poses significant challenges in clinical management. This article presents a patient with ACTH-dependent Cushing′s syndrome where the ACTH-secreting source could not be definitively localized from our hospital. Additionally, the article reviews recent advancements in the diagnosis and treatment of such cases, both domestically and internationally, with the aim of enhancing clinicians′ understanding and improving the management of this condition.

OBJECTIVE To provide technical support for improving recognition rate of adverse drug events （ADEs） related to traditional Chinese medicine （TCM） formula granules and decoction pieces among inpatient patients. METHODS By referencing the global trigger tool （GTT） whitepaper， literature on adverse reactions to TCM， and expert review opinions， ADE trigger items for TCM formula granules and decoction pieces used in the inpatients were established. GTT was applied to analyze ADEs in inpatients who had used TCM formula granules and decoction pieces in our hospital from August 2013 to August 2023， utilizing the Chinese Hospital Pharmacovigilance System. The effectiveness of GTT and the characteristics of these ADEs were analyzed. RESULTS A total of forty-eight triggers were established， including thirty-two laboratory test indexes， thirteen clinical symptoms， and three antidotes. Among the 1 682 patients included， GTT identified 652 potential ADEs， 284 true positive ADEs，with a trigger rate of 38.76% and a positive predictive value of 43.56%. After review by the auditor， 278 cases of ADEs were finally confirmed， with an incidence rate of 16.53%， significantly higher than the number of spontaneously reported ADEs during the same period （0）. The 278 cases of ADEs were mostly grade 1 （223 cases）， mainly involving hepatobiliary system， gastrointestinal system， blood- lymphatic system， etc；a total of 219 types of TCMs are involved，and the top five suspected TCMs used at a frequency higher than 1% were Poria cocos， Codonopsis pilosula， Atractylodes macrocephala， fried Glycyrrhiza uralensis， and Scutellaria baicalensis. CONCLUSIONS The established GTT can improve the recognition rate of ADEs for hospitalized patients using traditional Chinese medicine formula granules and decoction pieces.

Objective:To analyze the research and development of control system for airbag pressure of intelligent tracheal catheter,and its application effect in clinical practice.Methods:The hospital designed an intelligent self-adaptive control system for cuff pressure of tracheal catheter,which can rationally apply main components such as single chip microcomputer,display screen,control panel,pressure monitoring module,inflation device and solenoid valve,etc..This control system connected the measuring module of pressure through single chip microcomputer,so as to continuously detect the airbag pressure of tracheal catheter.An inflation and deflation algorithm was independently researched and developed to control air pump or solenoid valve to inject or release part of the gas to the airbag,so as to achieve intelligent control for the pressure of airbag.Sixty patients underwent endotracheal intubation who admitted to the department of general surgery of Wuhan Hospital of Traditional Chinese Medicine from January 2022 to January 2023 were selected as the study objects,and they were divided into control group(n=30)and observation group(n=30)according to random number table method.The cuff pressure of endotracheal intubation of patients in control group were managed by conventional method.The intelligent adaptive control system was adopted to manage the cuff pressure of endotracheal intubation for patients in the observation group.The complications,compliance rate of airbag pressure,the instantaneous maximum value of airbag pressure during sputum aspiration,insertion of gastric tube,and turning over of body were compared between the two groups after intubation.Results:The incidence of complication included cough,trachyphonia,dysphagia and bloody sputum after tracheal intubation in the observation group were 6.66%,which was significantly lower than 33.33%in the control group,and the difference was statistically significant(x2=6.667,P<0.05).The compliance rate of the pressure(25-30cmH2O)of airbag in the control group was 92.83%,which was significantly lower than 97.78%in the observation group,and the difference was statistically significant(x2=14.698,P<0.05).The instantaneous maximum values of airbag pressure during sputum aspiration,insertion of gastric tube and turning over were(28.24±3.65)cmH2O,(27.98±4.25)cmH2O and(28.65±4.87)cmH2O in observation group,respectively,which were significantly lower than those in control group,and the differences were significant(t=17.930,19.208,16.485,P<0.05).Conclusion:The application of intelligent adaptive control system for cuff pressure of tracheal catheter can maintain the airbag pressure of tracheal catheter at normal level(20-30 cmH2O),and reduce complications,and improve the compliance rate of airbag pressure.

Objective:To investigate the impact of immunosuppressive therapy on the severity of SARS-CoV-2 infection and cytokine levels in pediatric patients with kidney diseases.Methods:A retrospective analysis was conducted on the clinical data of 40 hospitalized pediatric patients who were diagnosed with SARS-CoV-2 infection at the 900th Hospital of PLA Joint Logistic Support Force from December 2022 to February 2023. Based on their immunosuppressive status prior to SARS-CoV-2 infection, these patients were categorized into immunosuppressive group and non-immunosuppressive group. Independent sample t-tests, Mann-Whitney U tests, and χ2 test were employed to compare the clinical baseline characteristics and laboratory data, the severity of SARS-CoV-2 infection, and the levels of cytokines between the 2 groups. Results:Among the 40 patients, 11 were in the immunosuppressive group (aged 13 (8, 14) years, 9 males and 2 females) and 29 in the non-immunosuppressive group (aged 2 (1, 4) years, 15 males and 14 females). In the immunosuppressive group, 2 were asymptomatic cases, 8 were mild cases, and 1 was moderate case, and there was no severe or critical cases. In the non-immunosuppressive group, 8 were mild cases, 5 were moderate, 15 were severe cases, 1 was critical case, and no asymptomatic cases. The underlying diseases in the immunosuppressive group included nephrotic syndrome (6 cases), IgA vasculitis nephritis (2 cases), lupus nephritis (1 case), post-renal transplantation (1 case), and renal failure (1 case), with a mean total immunosuppression score (TIS) of (3.6±1.4) points. In the non-immunosuppressive group, 2 patients had a history of epilepsy, and the remaining 27 cases had no underlying conditions, all with TIS scores of 0. Compared to the children in the non-immunosuppressive group, those in the immunosuppressive group were more likely to exhibit asymptomatic or mild infection, with lower risks of severe disease, cytokine storm, fever, and cough, but a higher risk of fatigue ( OR=1.22, 2.66, 0.48, 0.12, 0.12, 0.13, 1.22; 95% CI 0.93-1.62, 0.99-7.15, 0.33-0.70, 0.03-0.57, 0.03-0.57, 0.03-0.65, 0.93-1.62; all P<0.05). The levels of cytokine IL-6, interferon-α and interferon-γ in the immunosuppressive group were all lower than those in the non-immunosuppressive group ( Z=2.23, 2.51, 2.92, respectively; all P<0.05). Conclusion:Pediatric patients with kidney diseases receiving appropriate immunosuppressive therapy may mitigate the severity of SARS-CoV-2 infection by suppressing the expression of cytokines.