Objective To investigate the relationship between serum small dense low density lipoprotein cholesterol(sdLDL-C),systemic inflammatory response index(SIRI),monocyte to high density lipoprotein cholesterol ratio(MHR)and coronary artery injury(CAL)and intravenous immunoglobulin(IVIG)treat-ment response in Kawasaki disease(KD)children.Methods From April 2021 to December 2023,121 KD children(KD group)admitted to our hospital were divided into CAL group(42 cases)and NCAL group(79 cases)according to whether CAL occurred.Another 121 healthy children who underwent physical examina-tions in the hospital during the same period were selected as the control group.All the children in the KD group received IVIG treatment and were divided into the IVIG response group(99 cases)and the IVIG non-response group(22 cases)according to the treatment response.The differences in serum sdLDLC,SIRI and MHR levels among each group were compared.Univariate and multivariate Logistic regression models were used to analyze the factors influencing the non-response of children with KD to IVIG treatment,and the re-ceiver operating characteristic(ROC)curve was used to analyze the value of serum sdLDL-C,SIRI,and MHR in predicting the non-response of children with KD to IVIG treatment.Results Serum levels of sdLDL-C,SI-RI and MHR in the KD group were higher than those in the control group(P＜0.05).Serum levels of sdLDL-C,SIRI and MHR in the CAL group were higher than those in the NCAL group(P＜0.05).Serum levels of sdLDL-C,SIRI and MHR in the IVIG non-response group were higher than those in the IVIG response group(P＜0.05).The fever duration in the IVIG non-response group was longer than that in the IVIG response group(P＜0.05),and the combined proportion of CAL,the proportion of neutrophils,white blood cell count,C-reactive protein(CRP),interleukin-6(IL-6),erythrocyte sedimentation rate,and ferritin level were higher than those in the IVIG response group(P＜0.05).High CRP level,high sdLDL-C level,high SIRI and high MHR were risk factors for response to IVIG treatment in children with KD(P＜0.05).The areas under the curve(AUC)of serum sdLDL-C,SIRI,and MHR for predicting response to IVIG treatment in children with KD were 0.773,0.767,and 0.780 respectively.The combined prediction AUC was 0.948,which was higher than the individual predictions of each index.Conclusion The abnormal increase of serum sdLDL-C,SIRI and MHR in KD children is related to the occurrence of non-response to CAL and IVIG treatment.The combina-tion of the three can effectively predict the response to IVIG treatment.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.