[Objective] To validate and optimize the platelet transfusion refractoriness (PTR) prediction model for patients with hematological disorders established by our center. [Methods] The data of patients with hematological diseases who received platelet transfusions from December 2021 to December 2022 were used as the training set, and data from January 2023 to December 2023 as the validation set. The validation set data was used to validate the predictive model constructed on the training set. Relevant risk factors for PTR were collected through literature review and preliminary studies。 The patients were divided into effective and ineffective groups according to the corrected count increment (CCI) of platelet counts. Predictive factors were screened using univariate and multivariate logistic regression. The calibration of the model were assessed via calibration curves, while discrimination, accuracy, sensitivity, and specificity were evaluated using receiver operating characteristic (ROC) curves Clinical utility was further analyzed with decision curve analysis (DCA). [Results] The Hosmer-Lemeshow (H-L) goodness-of-fit test for the validation set yielded S: P=0.000, indicating that the original model needs optimization. Baseline comparisons and logistic regression identified the number of red blood cell units (RBCU) and platelet units (PLT-U) transfused as key predictors for the optimized model. The H-L goodness-of-fit test S: P values for the training and validation sets were 0.930 and 0.056, respectively; the ROC areas were 0.793 5 and 0.809 4, specificities 90.95% and 84.21%, sensitivities 59.26% and 70.04%, and accuracies 78.14% and 74.10%, respectively. DCA demonstrated clinical net benefit within a prediction probability threshold range of 0.2-0.8. [Conclusion] Transfusion volumes of RBC-U and PLT-U were inversely associated with PTR in hematological patients. The resulting PTR prediction model exhibits moderate predictive efficacy and clinical benefit.

Objective:To investigate the intelligence status of children aged 10 - 12 in rural areas of Linxia Hui Autonomous Prefecture (referred to as Linxia) in Gansu Province.Methods:From September to November 2019, a cross-sectional study was carried out to investigate the intelligence status of children aged 10 to 12 in 8 counties (cities) of Linxia. Chinese Raven's Progressive Matrices (rural version) was used for intelligence test and children's intelligence quotient (IQ) was calculated by regular mold to evaluate children's intelligence level.Results:A total of 1 721 children in Linxia were tested for intelligence, with an average IQ of 103.2. Among them, low intelligence (≤69) accounted for 1.0% (18/1 721), borderline (70 - 79) accounted for 3.0% (52/1 721), middle and lower (80 - 89) accounted for 8.4% (144/1 721), moderate (90 - 109) accounted for 56.6% (974/1 721), middle and upper (110 - 119) accounted for 21.9% (377/1 721), excellent (120 - 129) accounted for 7.8% (135/1 721), extremely excellent (≥130) accounted for 1.2% (21/1 721). There were 635, 598 and 488 children aged 10, 11 and 12, respectively, with an average IQ of 106.1, 103.3 and 99.2. There were 919 males and 802 females, with an average IQ of 102.9 and 103.4, respectively.Conclusion:In 2019, the intelligence of children aged 10 to 12 in rural areas of Linxia has reached the moderate level.

Objective:To explore the clinical characteristics of children with septic shock and analyze the drug resistance of blood culture positive bacteria.Methods:The clinical data,positive blood culture strains and drug sensitivity results of 127 children with septic shock admitted to the Department of Intensive Care Medicine of Hunan Children's Hospital from September 2015 to August 2021 were retrospectively analyzed.Results:A total of 134 strains of bacteria or fungi were isolated from the blood culture samples of 127 children with septic shock,and gram-negative strains were the main ones,accounting for 67.16% (90/134).Haemophilus influenzae and Escherichia coli were the main gram-negative bacteria,accounting for 38.81% (52/134) and 20.15% (27/134)，respectively,while Streptococcus pneumoniae was the main gram-positive bacteria,accounting for 8.21% (11/134),and Candida albicans was the main fungus,accounting for 10.45% (14/134).The number of white blood cells,the levels of serum C-reactive protein,procalcitonin,venous blood sugar and arterial blood lactic acid in patients were all significantly higher than normal values,and the white blood cells count and neutrophil percentage in gram-positive bacterial infections were significantly higher than those with gram-negative bacterial infections and fungal infections( P<0.05).Procalcitonin increased most obviously when infected by gram-negative bacteria,and the difference was statistically significant ( P<0.05).Gram-positive strains were sensitive to vancomycin,teicoplanin,and linezolid,but only 50% of Streptococcus pneumoniae were sensitive to penicillin.Gram-negative strains had relatively high drug resistance,among which Klebsiella pneumoniae were only highly resistant to imipenem,cilastatin and levofloxacin,reaching 50%.Haemophilus influenzae was resistant to cephalosporins and β-amides enzyme antibiotic,and the drug sensitivity rate of lactamase antibiotics was high,with a resistance rate of 50% only to ampicillin,cefuroxime,amikacin,and compound sulfamethoxazole.There were not many fungal strains,and most antifungal drugs were effective against blood culture-positive fungi. Conclusion:The main pathogens of infection in children with septic shock are gram-negative bacteria,and have high resistance to general antibiotics.We should pay attention to their drug resistance when using antibiotics empirically.

Objective To explore the risk factors for platelet transfusion refractoriness(PTR)in patients with hemato-logical disorders,construct a prediction model and validate the model efficacy.Methods Patients with hematological disor-ders who received platelet transfusion therapy in the Chengdu Second People's Hospital from December 2021 to December 2022 were retrospectively included to judge the effectiveness of platelet transfusion and screened for risk factors by univariate and multivariate logistic regression.A prediction model for PTR was constructed using receiver operating characteristic(ROC)curve,calibration curve and decision curve(DCA)to assess the differentiation,calibration and clinical value of the model,respectively.Results A total of 334 hematological patients were included,including 168 males and 176 females,with a PTR incidence of 40.4%.Univariate and multivariate logistic regression analysis showed that platelet transfusion vol-ume,erythrocyte transfusion volume,and neutrophil ratio were risk factors for PTR(P<0.05).A prediction model for PTR in hematological patients was established based on these risk factors.The area under the model's curve was 0.8377(95%CI:0.723-0.772),the sensitivity was 58.52%,and the specificity was 89.95%.The calibration curve showed that the S∶P was 0.964,the maximum absolute difference Emax was 0.032,and the average absolute difference Eavg was 0.009.The DCA a-nalysis showed that the model had clinical application value when the risk threshold ranged from 0.2 to 0.9.Conclusion The PTR prediction model based on platelet transfusion volume,erythrocyte transfusion volume and neutrophil ratio can pro-vide a basis for effective platelet transfusion in hematological patients.

Objective:To explore the distribution characteristics of common clinical manifestations of elbow joint in patients with endemic fluorosis and their correlation with the influencing factors.Methods:A cross-sectional survey was conducted on all permanent adult residents in 13 endemic fluorosis villages in Gaotai and Gaolan counties of Gansu province. The survey included: ① Demographic information, family history, and current medical history. ② Physical examination specifically focued on the orthopedic clinical presentations. ③Taking DR films of the forearm (including elbow joint) and calf (including knee joint), and classify the elbow joint to grade K-L based on X-ray manifestations. ④ Measuring height and weight, and calculating BMI index. ⑤Applying the Mayo elbow joint rating scale to evaluate elbow joint function. Based on the survey results, the distribution characteristics of clinical symptoms and signs of elbow joint in patients with skeletal fluorosis, as well as the distribution characteristics and correlation of factors affecting elbow joint function such as age, gender, disease course, BMI, K-L grade, etc were described. The comparison of counting data and rates were analyzed with χ2 test or Fisher exact probability test. Pearson′s test was used for correlation analysis of continuous data that conforms to normal distribution, and Spearman test was used for non-normal distribution measurement and counting data. The correlation analysis of ordered hierarchical data was conducted using Kendall′s Tau- b test. Results:①Among 501 patients with skeletal fluorosis, a total of 465 cases (92.8%) were diagnosed with elbow joint pain. A total of 185 cases (36.9%) were with elbow joint tenderness, 300 cases (59.9%) were with elbow joint enlargement, 415 cases (82.8%) were with morning stiffness of the elbow joint, 102 cases (20.4%) were with cubital tunnel syndrome, 153 cases (30.5%) were with positive forearm extensor tendon traction test, and 97 cases (19.4%) were with positive forearm flexor tendon traction test. The detection rate of elbow joint rotation limitation was the highest among those with ROM ranging from 30 ° to 70 ° (261/501, 52.1%), and the detection rate of elbow joint extension and flexion limitation was the highest among those with ROM ranging from 50 ° to 90 °(274/501, 54.7%). ②Among 501 patients with skeletal fluorosis, a total of 465 cases were found to have symptoms and positive signs in the elbow joint, with the detection rate in males being lower than that in females, with a significant difference ( χ2=41.19, P<0.001). The majority of patients were between the ages of 50 and 65 (274/501, 58.9%), with a body mass index of <18 (217, 46.67%), K-L arthritis with a radiologic grade of Ⅲ (256/501, 55.0%), and a disease course of >30 years (217/501, 46.67%). ③The correlation between clinical characteristics, the Mayo score, and various influencing factors of skeletal fluorosis found a high correlation between pain and age ( r=0.79, P<0.001) and pain and disease course ( r=0.71, P<0.001). The ROM of extension and flexion was negatively correlated with age ( r=-0.43, P<0.001), K-L grade ( r=-0.67, P<0.001), and disease course ( r=-0.48, P<0.001); Elbow tunnel syndrome was positively correlated with age ( r=0.72, P<0.001). The Mayo functional score was negatively correlated with age ( r=-0.35, P<0.001). Conclusion:Early morning stiffness of the elbow joint (<30 min), limited rotation of the elbow joint, limited extension and flexion of the elbow joint, and cubital tunnel syndrome (degree Ⅰ) have a high detection rate in the population with skeletal fluorosis. Age, course of disease, and degree of joint degeneration have a significant impact on elbow joint function in patients with fluorosis.

Objective:To investigate the epidemiological situation of drinking water-type endemic fluorosis in Gansu Province, and scientifically evaluate the effectiveness of water improvement and fluoride reduction projects in preventing and controlling the disease.Methods:The drinking water-type endemic fluorosis areas in Gansu Province were divided into five regions according to different ecological types: the Longzhong Loess Plateau Hilly Area in central Gansu, the Longdong Loess Plateau Gully Area in eastern Gansu, the Longnan Qinling Zhongshan Canyon Area in southern Gansu, the Gobi area of the Hexi Desert, and the Alpine Grassland Meadow Area in southern Gansu. In 2021, a survey was conducted on the basic situation, running situation of the water improvement and fluoride reduction projects, fluoride content in drinking water(fluorine ion-selective electrode), and the prevalence of dental fluorosis (Dean) among children aged 8 to 12 in all drinking water-type endemic fluorosis villages in the five regions. The pertinent assessments were executed in accordance with national guidelines such as the "Standards for Drinking Water Quality" (GB 5749-2006) and "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results:A total of 2 000 villages in drinking water-type endemic fluorosis areas were monitored, among which 1 999 villages had implemented water improvement and fluoride reduction projects, with a coverage rate of 99.95% (1 999/2 000). All water improvement and fluoride reduction projects were operating normally, with no intermittent operation or scrapping. A total of 34 616 children aged 8 to 12 were investigated for dental fluorosis. The detection rate of dental fluorosis was 4.18% (1 448/34 616), and the dental fluorosis index was 0.09. There was a statistically significant difference in the detection rate of dental fluorosis among children of different ages (χ 2 = 69.77, P < 0.001). The difference in the detection rate of dental fluorosis among children of different ecological types of areas was statistically significant (χ 2 = 775.11, P < 0.001). The dental fluorosis index of children aged 8 - 12 was significantly correlated with the historical water fluoride level ( r = 0.29, P = 0.042). The water improvement time in the Gobi area of the Hexi Desert was significantly correlated with the detection rate of dental fluorosis in local children ( r = - 0.48, P = 0.023). Conclusions:In 2021, the prevention and control of drinking water-type endemic fluorosis in all villages in Gansu Province has reached the national control standards. However, due to the different ecological characteristics and changes in water source distribution in different ecological types of areas, it is still necessary to further strengthen the monitoring of the condition of drinking water-type endemic fluorosis in all the affected villages and consolidate the existing prevention and control achievements.

Objective:To investigate the protective effect and mechanism of ophiopogonin D on lung injury induced by radiation in mice.Methods:A total of 60 female C57BL/6 mice were randomly divided into 4 groups: control group, irradiation group, irradiation+ ophiopogonin D group and irradiation+ dexamethasone group, with 15 mice in each group. The mice were irradiated with a single dose of 6 MV X-rays of 15 Gy. Three days before irradiation, the mice in irradiation+ ophiopogonin D group were intraperitoneally injected with 10 mg/kg ophiopogonin D solution. The mice in irradiation+ dexamethasone group were intraperitoneally injected with 10 mg/kg dexamethasone solution. The mice in control group and irradiation group were intraperitoneally injected with normal saline once a day until 1 week after irradiation. Tissue samples were collected at 3 d, 1 week, and 6 weeks post-irradiation. Hematoxylin-eosin (HE) staining and Masson′s trichrome staining were used to observe the pathological changes of lung tissue. The expressions of 8-hydroxy-deoxyguanosine (8-OHdG), p53, p53 up-regulated apoptosis factor (PUMA), cysteine aspartate proteolytic enzyme-3 (caspase-3), Collagen Ⅰ and Collagen Ⅲ were observed by immunohistochemistry. Western blot was used to verify the expressions of apoptosis related proteins including p53, PUMA and caspase-3.Results:HE staining of lung tissue showed that ophiopogonin D could reduce hemorrhage, exudation, edema and inflammatory infiltration in lung tissue 1 week post irradiation. Moreover, ophiopogonin D reduced the expression of 8-OHdG ( t=8.39, P < 0.05), the oxidative stress, and the expressions of p53, PUMA, caspase-3 apoptosis-related proteins ( t=12.60, 5.92, 7.00, P < 0.05), and inhibited the apoptosis of alveolar epithelial cells and alleviated other damage in the irradiated lung tissue 1 week post-irradiation. Ophiopogonin D also reduced collagen deposition in lung tissue 6 weeks after irradiation, and reduced the expression of transforming growth factor (TGF-β1) ( t=9.32, 8.97, 6.83, P < 0.05) and interleukin-6 ( t=8.22, 7.80, 8.28, P < 0.05) in the blood of mice at 3 d, 1 week, and 6 weeks after irradiation. At 6 weeks after exposure, ophiopogonin D reduced the production of Collagen Ⅰ and Collagen Ⅲ in the lung interstitium ( t=6.41, 7.50, P < 0.05), and alleviated the pulmonary fibrosis in the late stage of radiation. Conclusions:Ophiopogonin D has protective effects on lung injury caused by radiation, including the alleviation of early radiation pneumonia and late pulmonary fibrosis, by reducing oxidative stress, the expression of inflammation-related factors, apoptosis of lung tissue, and collagen production.

Objective:To investigate the intention of medical students to be vaccinated against COVID-19 and to analyze the influencing factors.Methods:A self-filled electronic questionnaire survey was conducted among medical students from a medical school in Shanghai randomly selected from June 21 to 29, 2021. The questionnaire contained items of basic information, intention for COVID-19 vaccination, awareness of COVID-19 prevention measures and awareness of COVID-19 vaccine. Logistic regression was used to analyze the influencing factors.Results:The average age of the 966 respondents was (20.4±2.9) years, and 63.6% (614/966) of them were female;23.7% (229/966) of them had family members or relatives who had participated in anti-pandemic work or volunteer service;90.6% (875/966) of the respondents expressed they were very willing or willing to be vaccinated against COVID-19. The majority of the respondents thought that “COVID-19 infection is very serious” (94.3%, 911/966), “good protection can effectively prevent COVID-19 infection” (92.4%, 893/966), and “they can fully implement all kinds of protection measures” (73.5%, 710/966). About half of the respondents (51.8%, 501/966) knew about the adverse reactions and contraindications of COVID-19 vaccine. The low protected capability (47.4%, 458/966), short duration of protection (50.6%, 489/966), and many side effects (48.7%, 470/966) were the major concerns about COVID-19 vaccine. Logistic regression analysis showed that people thought that “COVID-19 infection is very serious” ( OR=5.30, 95 %CI:2.60-10.81, P<0.001), thought that “good protection can effectively prevent COVID-19 infection” ( OR=2.46, 95 %CI:1.26-4.81, P=0.009), thought that “they can fully implement all kinds of protection measures” ( OR=2.55, 95 %CI:1.53-4.25, P<0.001) were more willing to receive COVID-19 vaccination. While those concerned about vaccine quality did the opposite ( OR=0.29, 95 %CI:0.13-0.65, P=0.003). Conclusions:Medical students have a high intention of vaccination against COVID-19. The vaccine-related knowledge quality should be emphasized in future publicity to further enhance the intention of COVID-19 vaccination.

Based on the GAPS(goal, analyze, problem, solution) management model, the authors analyzed the problems existing in the practice of prescription audit and the strategies of continuous optimization. Multi-disciplinary team(MDT) and evidence-based practice were applied to help the continuous optimization of prescription audit practice and promote the rational drug use management of medical institutions. Through the establishment of accurate control process, the personalized management of prescription dosage of chronic diseases, perioperative drugs, special grade antibiotics and auxiliary drugs was realized. The practice of prescription audit based on the GAPS management model, on the one hand, could improve the quality and efficiency of prescription audit, gradually improve the qualified rate of prescription, strengthen clinical use intervention and promote rational drug use; On the other hand, it could reflect the value of pharmacists′ professional technicians, provide patients with more high-quality pharmaceutical care, and gradually realize the prescription audit mode of " improving quality, controlling cost and increasing efficiency" .

Objective: To analyze the predictive value of the mortality risk score for severe hand, foot and mouth disease(MRSHFMD) system for the complications and mortality risk of severe hand, foot and mouth disease(HFMD) in children. Methods: This study included 354 children with severe HFMD who admitted in the pediatric intensive care unit(PICU) of Hunan Provincial Children′s Hospital from March 2012 to March 2014.The patients were grouped according to whether they had complicated nervous system damage, pulmonary edema, pulmonary hemorrhage and circulatory failure in the course of disease, and the prognosis was grouped according to their 28 d survival.The worst values of white blood cell count, blood glucose, blood lactic acid, N-terminal pro-brain natriuretic peptide, within 24 hours after admission were used to score MRSHFMD.The predictive value of MRSHFMD for nervous system damage, pulmonary edema, pulmonary hemorrhage, circulatory failure, and prognosis were evaluated using the receiver operating characteristic(ROC)curve. Results: The blood glucose, white blood cell count, blood lactic acid value, N-terminal pro-brain natriuretic peptide and MRSHFMD score of the children with HFMD complicated with nervous system damage, pulmonary edema, pulmonary hemorrhage and circulatory failure were significantly higher than those in the non-complicated groups(P<0.01). When the cut-off value of MRSHFMD score was 3, the area (95%CI) under the ROC curve were 0.723 (0.643-0.804), 0.870 (0.793-0.946), 0.921 (0.85-0.992), 0.944 (0.867-1.000) and 0.954 (0.000-1.000) of nervous system damage, pulmonary edema, pulmonary hemorrhage, circulation failure and death in children with HFMD, respectively.The specificity and sensitivity of predicting nervous system damage, pulmonary edema, pulmonary hemorrhage, circulatory failure and death were 44.6% and 95.8%; 67.5% and 95.5%; 83.3% and 95.1%; 89.3% and 95.1%; 90.9% and 93.7%, respectively. Conclusion MRSHFMD system is an effective tool to predict HFMD complications of pulmonary hemorrhage, circulatory failure, and death, which is worthy of clinical promotion.