Objective To investigate the prognostic value of the platelet-to-lymphocyte ratio(PLR)at different early time points in adult patients undergoing veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective study was conducted,selecting 55 adult patients who underwent VA-ECMO treatment at the First Hospital of Jiaxing from June 2020 to October 2022 as the study subjects.Then,the patients'gender,age,past history[including hypertension,diabetes,heart disease,chronic obstructive pulmonary disease(COPD)],and the reason for extracorporeal membrane pulmonary oxygenation(ECMO)adjuvant therapy[including severe myocarditis,acute myocardia infarction,in-hospital and out-of-hospital cardiac arrest,severe closed craniocerebral injury,severe pneumonia,pelvic fracture,other(pulmonary embolism,electrocution,traumatic hepatic rupture,post-partum hemorrhage,severe acute pancreatitis,crush syndrome)],acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)at the time of admission,and ECMO peripheral blood tests[creatinine,alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood lactate acid(Lac),white blood cell count(WBC),neutrophil count(NEU),lymphocyte count(LYM),hemoglobin(Hb),and platelet count(PLT)]and the last time prior to ECMO assistance,24 hours prior to the occurrence of acute kidney injury(AKI),and 24 hours after the occurrence of AKI.PLR levels at 24 hours ECMO,and the proportion of continuous renal replacement therapy(CRRT).The patients were divided into a death group and a survival group based on their 30-day prognosis and further categorized into a CRRT group and a non-CRRT group based on whether CRRT was administered.Clinical indicators of patients with different prognosis and the differences in PLR levels between CRRT and non-CRRT groups were compared.Logistic regression analysis was used to identify independent risk factors affecting the 30-day prognosis of VA-ECMO patients.The receiver operator characteristic(ROC curves)were plotted to evaluate the prognostic predictive value of each risk factor.Results Compared to the survival group,the death group had significantly higher APACHEⅡscores,SOFA scores,LYM and proportion receiving CRRT[APACHEⅡscore:34.00(28.50,36.00)vs.25.00(14.75,34.00),SOFA score:5.00(4.00,6.50)vs.3.00(2.00,5.25),LYM(×109/L):3.40±1.97 vs.2.24±2.11,proportion receiving CRRT:91.30%(21/23)vs.62.50%(20/32)],and a significantly lower level of the last PLR prior to ECMO adjuvant[30.00(21.06,48.17)vs.58.82(41.80,145.72)],and the differences were statistically significant(all P<0.05).Logistic regression analysis showed that the levels of the last PLR before ECMO assistance[odds ratio(OR)=0.965,95%confidence interval(95%CI)was 0.938-0.993,P=0.013],APACHEⅡscore at the time of admission(OR=1.121,95%CI was 1.018-1.234,P=0.020),and CRRT(OR=7.734,95%CI was 1.042-57.401,P=0.045)were independent risk factors affecting the prognosis of the VA-ECMO patients at 30 days after adjuvant;the ROC curve analysis showed that APACHEⅡscore,CRRT and the last PLR level before ECMO assistance had a predictive value for the prognosis of VA-ECMO patients 30 days after assistance,in which the APACHEⅡscore+the last PLR level before ECMO assistance had the greatest predictive value in predicting the prognosis of the patients,with area under the curve(AUC)of 0.846,with a sensitivity of 62.5%and a specificity of 95.7%.Higher early PLR levels were associated with better prognosis.In the CRRT group,PLR levels at 24 hours before ECMO initiation,24 hours before AKI onset,and 24 hours after AKI onset were significantly lower than those in the non-CRRT group(all P<0.05).Conclusion Early PLR levels and CRRT administration have significant predictive value for the prognosis of patients undergoing VA-ECMO therapy.

Objective To investigate the prognostic value of the platelet-to-lymphocyte ratio(PLR)at different early time points in adult patients undergoing veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective study was conducted,selecting 55 adult patients who underwent VA-ECMO treatment at the First Hospital of Jiaxing from June 2020 to October 2022 as the study subjects.Then,the patients'gender,age,past history[including hypertension,diabetes,heart disease,chronic obstructive pulmonary disease(COPD)],and the reason for extracorporeal membrane pulmonary oxygenation(ECMO)adjuvant therapy[including severe myocarditis,acute myocardia infarction,in-hospital and out-of-hospital cardiac arrest,severe closed craniocerebral injury,severe pneumonia,pelvic fracture,other(pulmonary embolism,electrocution,traumatic hepatic rupture,post-partum hemorrhage,severe acute pancreatitis,crush syndrome)],acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)at the time of admission,and ECMO peripheral blood tests[creatinine,alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood lactate acid(Lac),white blood cell count(WBC),neutrophil count(NEU),lymphocyte count(LYM),hemoglobin(Hb),and platelet count(PLT)]and the last time prior to ECMO assistance,24 hours prior to the occurrence of acute kidney injury(AKI),and 24 hours after the occurrence of AKI.PLR levels at 24 hours ECMO,and the proportion of continuous renal replacement therapy(CRRT).The patients were divided into a death group and a survival group based on their 30-day prognosis and further categorized into a CRRT group and a non-CRRT group based on whether CRRT was administered.Clinical indicators of patients with different prognosis and the differences in PLR levels between CRRT and non-CRRT groups were compared.Logistic regression analysis was used to identify independent risk factors affecting the 30-day prognosis of VA-ECMO patients.The receiver operator characteristic(ROC curves)were plotted to evaluate the prognostic predictive value of each risk factor.Results Compared to the survival group,the death group had significantly higher APACHEⅡscores,SOFA scores,LYM and proportion receiving CRRT[APACHEⅡscore:34.00(28.50,36.00)vs.25.00(14.75,34.00),SOFA score:5.00(4.00,6.50)vs.3.00(2.00,5.25),LYM(×109/L):3.40±1.97 vs.2.24±2.11,proportion receiving CRRT:91.30%(21/23)vs.62.50%(20/32)],and a significantly lower level of the last PLR prior to ECMO adjuvant[30.00(21.06,48.17)vs.58.82(41.80,145.72)],and the differences were statistically significant(all P<0.05).Logistic regression analysis showed that the levels of the last PLR before ECMO assistance[odds ratio(OR)=0.965,95%confidence interval(95%CI)was 0.938-0.993,P=0.013],APACHEⅡscore at the time of admission(OR=1.121,95%CI was 1.018-1.234,P=0.020),and CRRT(OR=7.734,95%CI was 1.042-57.401,P=0.045)were independent risk factors affecting the prognosis of the VA-ECMO patients at 30 days after adjuvant;the ROC curve analysis showed that APACHEⅡscore,CRRT and the last PLR level before ECMO assistance had a predictive value for the prognosis of VA-ECMO patients 30 days after assistance,in which the APACHEⅡscore+the last PLR level before ECMO assistance had the greatest predictive value in predicting the prognosis of the patients,with area under the curve(AUC)of 0.846,with a sensitivity of 62.5%and a specificity of 95.7%.Higher early PLR levels were associated with better prognosis.In the CRRT group,PLR levels at 24 hours before ECMO initiation,24 hours before AKI onset,and 24 hours after AKI onset were significantly lower than those in the non-CRRT group(all P<0.05).Conclusion Early PLR levels and CRRT administration have significant predictive value for the prognosis of patients undergoing VA-ECMO therapy.

Objective:To explore the value of size-specific dose estimate (SSDE) based on effective diameter and water equivalent diameter ( Dw) in pediatric head CT. Methods:A retrospective analysis of 187 children underwent unenhanced head CT scanning were reviewed and divided into 3 groups according to the age: Group 1 (<1 m), Group 2(≥1 m~6 y), Group 3 (≥6~14 y). All CTDI vol values were recorded. The central axial image in the scanning range was selected. The region of interest (ROI) containing all anatomical structures (including skin) was outlined and the area of ROI ( AROI), head circumference, average CT value (CT ROI) were measured. The Dw, conversion factor fH16 and SSDE were calculated. The CTDI vol, SSDE and the rate of change( Δvalue)were compared among groups. The regression model between CTDI vol and SSDE was established. Results:The Dw values of groups 1-3 were (11.24±0.51), (14.48±1.47), (16.69±0.90)mm, respectively. The CTDI vol values were(15.36±2.78), (18.83±4.60), (23.24±4.13)mGy, respectively. SSDE values were(27.92±4.91), (29.16±6.64), (32.38±5.35)mGy, respectively. The differences among Dw, CTDI vol and SSDE groups were all statistically significant ( F=207.69、38.48、8.15, P<0.001). The values of Dw, CTDI vol and SSDE were gradually increasing while the age was increasing. However, the Δ value gradually was decreasing with increasing age. The linear regression equation of CTDI vol and SSDE was established as SSDE=7.252 + 1.137×CTDI vol. Conclusions:The radiation dose of children′s head CT can be accurately assessed based on Dw combined with head conversion factor fH16 to estimate the body-specific dose SSDE. The radiation dose of children′s head CT was underestimated with the greater degree for smaller age.

Objective To optimize the exposure parameters and reduce the irradiation dose level in infants and young children during digital radiography (DR) chest radiography under the premise of satisfied image quality.Methods The thoracic thickness of 100 patients were measured.Determined the aluminum equivalent of the thoraxes of the infants and young children by comparing the grayscale value and the aluminum step wedge.Another 100 infants and young children of experimental exposure were performed with the aluminum step wedge as a phantom,under AEC control,kV was the only variant to explore the optimal exposure parameters with dose monitor simultaneously.At last,clinical validation was performed.Images quality was compared with x2 test.The radiation dose of two groups was compared with t test.Results The maximum,minimum,average thoracic thickness and their correspondent aluminum equivalent were 13.5 and 2.3 cm,8.0 and 1.4 cm,(10.6 ± 1.3) and 2.0 cm,respectively.The average thoracic thickness of experimental group was (10.1 ± 2.2) cm.The range of entrance surface dose was 0.068-0.056 mGy while the tube voltage range was 55-65 kV.The exposure index range was 0.60-0.74.The visual inspection of aluminum step wedge was from grades 8 to 11 with satisfying image quality at lower radiation.The infant chest X-ray photography exposure parameters formula have been optimized,that was kV =thoracic thickness (cm) × 2 + 38 (constant),mAs (0.8-1.0) with SID =100 cm,without filter grid.Compare to the conventional parameters,the image quality of new method had no significant differences (P ＞ 0.05).The actual average entrance surface dose was (0.048 ± 0.007) mGy,lower than AEC group (0.066 ± 0.008) mGy.The difference was statistically significant (t =16.781,P ＜ 0.001).Conclusions The optimized formula kV =thoracic thickness (cm) ×2 + 38(constant),mAs (0.8-1.0) with SID =100 cm was credible for lowering the radiation exposure with good image quality for clinical diagnosis.