ObjectiveThis paper aims to explore the risk factors for chronic atrophic gastritis （CAG） with turbidity toxin accumulation syndrome and establish a prediction model. MethodsClinical data of 180 patients with CAG who participated in the "clinical study of Xianglian Huazhuo Particles blocking CAG cancer transformation" of Hebei Sheng Zhong Yi Yuan from July 2021 to March 2022 were collected. After confounding factors were controlled by propensity score matching， patients were divided into a training set （namely dev） and a validation set （namely vad） in a seven to three ratio. The risk factors for CAG with turbidity toxin accumulation syndrome in the training set were investigated by using univariate Logistic regression analysis and least absolute shrinkage and selection operator （namely Lasso） regression algorithms. Subsequently， a model， named model 1se， was developed by using the training set data to predict the risk factors for CAG with turbidity toxin accumulation syndrome. The accuracy of the prediction model was assessed by using various methods， including the receiver operating characteristic （ROC） curve， Hosmer-Lemeshow test （H-L）， calibration plot， and decision curve analysis （DCA）. ResultsAge， body mass index （BMI）， family history of cancer， job and life satisfaction， yellow and greasy fur with slippery pulse， and heavy body sensation were independent risk factors of the model. The prediction model showed excellent predictive value for both the training and validation sets. ConclusionThe established prediction model for CAG with turbidity toxin accumulation syndrome has high discrimination and excellent calibration， which could provide an excellent clinical basis for disease diagnosis and individualized treatment of patients.

ObjectiveThis paper aims to explore the risk factors for chronic atrophic gastritis （CAG） with turbidity toxin accumulation syndrome and establish a prediction model. MethodsClinical data of 180 patients with CAG who participated in the "clinical study of Xianglian Huazhuo Particles blocking CAG cancer transformation" of Hebei Sheng Zhong Yi Yuan from July 2021 to March 2022 were collected. After confounding factors were controlled by propensity score matching， patients were divided into a training set （namely dev） and a validation set （namely vad） in a seven to three ratio. The risk factors for CAG with turbidity toxin accumulation syndrome in the training set were investigated by using univariate Logistic regression analysis and least absolute shrinkage and selection operator （namely Lasso） regression algorithms. Subsequently， a model， named model 1se， was developed by using the training set data to predict the risk factors for CAG with turbidity toxin accumulation syndrome. The accuracy of the prediction model was assessed by using various methods， including the receiver operating characteristic （ROC） curve， Hosmer-Lemeshow test （H-L）， calibration plot， and decision curve analysis （DCA）. ResultsAge， body mass index （BMI）， family history of cancer， job and life satisfaction， yellow and greasy fur with slippery pulse， and heavy body sensation were independent risk factors of the model. The prediction model showed excellent predictive value for both the training and validation sets. ConclusionThe established prediction model for CAG with turbidity toxin accumulation syndrome has high discrimination and excellent calibration， which could provide an excellent clinical basis for disease diagnosis and individualized treatment of patients.

ObjectiveTo investigate the mechanism of Xiezhuo Jiedu prescription in the treatment of ulcerative colitis （UC） by inhibiting ferroptosis and alleviating intestinal mucosal injury based on the nuclear factor E₂ related factor 2/solute carrier family 7 member/glutathione peroxidase 4 （Nrf2/SLC7A11/GPX4） signaling pathway. MethodsA total of 60 male SD rats were divided into a normal group， a model group， high- and low-dose Xiezhuo Jiedu prescription groups （26.64 and 13.32 g·kg^-1， respectively）， a ferroptosis inhibitor group （Ferrostatin-1， 0.005 g·kg^-1）， and a mesalazine group （0.27 g·kg^-1）， with 10 rats in each group. A UC rat model was established by intrarectal administration of trinitrobenzene sulfonic acid （TNBS）-ethanol. The normal group and the model group were intragastrically administered normal saline. The other groups were given intragastric administration according to the corresponding dosage for 7 d. The general condition， disease activity index （DAI） score， colon length， and mucosal injury index （CDMI） score were observed in each group. The pathological changes of colon tissue in each group were observed by hematoxylin-eosin （HE） staining. The intestinal mucosa and mitochondrial morphology in each group were observed by transmission electron microscopy. The expression levels of Occludin， Claudin-1， mucin 2 （MUC2）， and E-cadherin in intestinal tissue were detected by immunofluorescence （IF）. Enzyme-linked immunosorbent assay （ELISA） was used to detect the expression levels of serum tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and interleukin-10 （IL-10） in each group， and a lactic acid assay kit or ELISA was employed to detect the expression levels of reactive oxygen species （ROS）， ferrous ions （Fe²⁺）， glutathione （GSH）， malondialdehyde （MDA）， 4-hydroxynonenal （4-HNE）， diamine oxidase （DAO）， and D-lactate （D-LA）. Real-time quantitative polymerase chain reaction （Real-time PCR） was applied to detect the mRNA expression levels of Nrf2， SLC7A11， GPX4， Occludin， Claudin-1， MUC2， and E-cadherin in each group， and Western blot was adopted to detect the protein expression levels of Nrf2， p-Nrf2， SLC7A11， and GPX4 in each group. ResultsCompared with the normal group， rats in the model group exhibited listlessness， sluggish response， and mucopurulent and bloody stools. The model group also showed significantly increased DAI score， colon length， CDMI score， and expression levels of TNF-α， IL-6， ROS， Fe²⁺， MDA， 4-HNE， DAO， and D-LA （P<0.01）. In addition， it presented significantly decreased IF values of Occludin， Claudin-1， MUC2， and E-cadherin and mRNA and protein expression levels of IL-10， GSH， Nrf2， p-Nrf2， SLC7A11， and GPX4 （P<0.01）. There were different degrees of improvement in each administration group after treatment， and the improvement was the most significant in the high-dose Xiezhuo Jiedu prescription group （P<0.01）. ConclusionXiezhuo Jiedu prescription may alleviate intestinal mucosal injury by inhibiting ferroptosis of intestinal epithelial cells via regulating the Nrf2/SLC7A11/GPX4 signaling pathway， thereby exhibiting efficacy in the treatment of UC.

Objective To summarize the clinical and genetic characteristics of end-stage renal disease caused by PLCE1 gene mutations.Methods A retrospective analysis of the clinical and genetic features of three children from a family with PLCE1 gene mutations was conducted,along with a literature review of hereditary kidney disease cases caused by PLCE1 gene mutations.Results The proband was an 8-year-old male presenting with nephrotic syndrome stage 4 chronic kidney disease.Renal biopsy showed focal segmental glomerulosclerosis.Two years and five months after kidney transplantation,the patient had persistent negative proteinuria and normal renal function.Whole-exome sequencing identified two pathogenic heterozygous variants:c.961C>T and c.3255_3256delinsT,with c.3255_3256delinsT being a novel mutation.Family screening revealed no renal involvement in the parents,but among five siblings,one brother died at age of 4 years from end-stage renal disease.A 7-year-old sister presented with proteinuria and bilateral medullary sponge kidney,with proteinuria resolving after one year of follow-up.A 3-year-old brother died after kidney transplantation due to severe pneumonia.The literature review included 45 patients with hereditary kidney disease caused by PLCE1 gene mutations.The main clinical phenotype was nephrotic syndrome(87%,39/45),and renal pathology predominantly showed focal segmental glomerulosclerosis(57%,16/28).No mutation hotspots were identified.Conclusions Compound heterozygous mutations in the PLCE1 gene can lead to rapid progression of the disease to end-stage renal disease,with favorable outcomes following kidney transplantation.Family screening is crucial for early diagnosis,and medullary sponge kidney may be a novel phenotype associated with these gene mutations.Citaion:[Chinese Journal of Contemporary Pediatrics,2025,27(5):580-587]

Objective:To prepare 89Zr-labeled anti-human podoplanin (PDPN) monoclonal antibody SZ168 and evaluate its feasibility for melanoma immunoPET imaging. Methods:89Zr-desferrioxamine (DFO)-SZ168 was prepared by conjugating p-isothiocyanatobenzyl (SCN-Bn)-DFO with SZ168 and chelating with 89Zr. Quality control analyses were conducted, including labeling rate, radiochemical purity, and in vitro stability. Melanoma mouse models were created, with experimental group ( n=3) and control group ( n=3) receiving tail vein injections of 89Zr-DFO-SZ168 and 89Zr-DFO-immunoglobulin (Ig)G solutions (3.7MBq) respectively. The experimental group underwent microPET/CT imaging at 12, 24, 48 and 72h post-injection, while the control group underwent imaging at 48h post-injection. Tumor and organ radioactivity uptake was analyzed using the ROI method. Mice were sacrificed at 7d post-injection to assess the ex vivo biodistribution of 89Zr-DFO-SZ168 and 89Zr-DFO-IgG. Independent-sample t test was used to analyze the data. Results:The pH value of the 89Zr-DFO-SZ168 solution was approximately 7.0, with a labeling rate >60%, radiochemical purity >95% after PD10 column purification, and good stability after 72h in vitro. Series microPET/CT imagings showed significant tumor visualization in tumor-bearing mice. Radioactivity uptake in tumors peaked at 48h post-injection, while the tumor was not clearly detected by 89Zr-DFO-IgG microPET/CT imaging. Ex vivo biodistribution indicated that 89Zr-DFO-SZ168 mainly accumulated in tumors, liver, and bones, with tumor uptake significantly higher than that of 89Zr-DFO-IgG ((29.36±7.29) percentage activity of injection dose per gram of tissue (%ID/g) vs (8.78±1.63) %ID/g; t=4.77, P=0.009). Immunohistochemistry of tumor specimens showed high expression of PDPN in tumor tissues. Conclusions:The probe 89Zr-DFO-SZ168 is successfully prepared, showing potential for specific molecular imaging diagnosis of melanoma. This lays a basis for developing PDPN molecular target-based immuno-PET diagnosis and integrated diagnosis and treatment for melanoma.

Objective To explore the relationship between levels of vascular endothelial growth factor(VEGF),insulin-like growth factor 1(IGF-1),and transforming growth factor-β1(TGF-β1)in the synovial fluid of children with avascular necrosis of the femoral head(also known as Perthes disease)and the efficacy of postoperative revascularization,aiming to provide a basis for subsequent diagnosis and treatment.Methods A retrospective study was conducted on 262 children with Perthes disease admitted to the Affiliated Hospital of Gansu University of Chinese Medicine from January 2023 to June 2024.Based on postoperative revascularization efficacy,patients were divided into good revascularization group(n=228)and poor revascularization group(n=34).For poor revascularization group,a 1:2 matched case-control design was used to select 68 age-matched children with hip synovitis who underwent hip joint fluid puncture as control group.Additionally,82 children with Perthes disease treated at the hospital from June 2024 to January 2025 were enrolled as a validation cohort for nomogram model verification.The expression levels of VEGF,IGF-1 and TGF-β1 in the synovial fluid of three groups were compared.Confounding biases were controlled through univariate and stratified analyses.Binary logistic regression analysis was used to identify independent factors affecting the revascularization effect.R software was utilized to draw and verify the nomogram model for predicting the postoperative revascularization effect.Results The levels of VEGF,IGF-1 and TGF-β1 in the synovial fluid of children in poor revascularization group were all higher than those in control group and good revascularization group(P<0.05).After three types of reconstructive surgeries,the levels of VEGF,IGF-1 and TGF-β1 in the synovial fluid of children with poor revascularization were all higher than those in children with good revascularization(P<0.05);however,there was no statistically significant difference in the above indicators among different surgical types(P>0.05).Binary logistic regression analysis showed that the levels of VEGF,IGF-1,and TGF-β1 in the synovial fluid were independent risk factors for poor postoperative revascularization in children with Perthes disease.The area under the ROC curve of the nomogram model established accordingly for predicting poor postoperative revascularization in children with Perthes disease was 0.875(95%CI 0.805-0.945),with a sensitivity of 0.874 and a specificity of 0.851.Moreover,the calibration curve and decision curve analysis(DCA)indicated that the model had good clinical applicability.Conclusions The increased levels of VEGF,IGF-1 and TGF-β1 in synovial fluid are associated with poor postoperative revascularization in children with Perthes disease.These three factors are expected to become prognostic indicators for children with Perthes disease.

Objective To provide a comprehensive description and summary of the clinical characteristics of eosinophilic granulomatosis with polyangiitis(EGPA)in order to enhance understanding of this disease.Methods A total of 33 EGPA patients treated in Zhongshan Hospital,Fudan University,between Jan 2017 and Aug 2022 were included in this retrospective analysis.The diagnosis was based on the 1990 American College of Rheumatology(ACR)classification criteria for EGPA.Clinical manifestations,laboratory examinations,and treatment outcomes of the patients were analyzed.Results Among the 33 EGPA patients,there were 22 males(66.7%)and 11 females(33.3%),with an average age of diagnosis being(47.42±15.83)years old.The most common initial department visited by patients was the rheumatology department(23 cases,69.7%),followed by the respiratory medicine department(6 cases,18.2%).Skin involvement manifested as rash,ulcers,necrosis or gangrene was observed in most cases(23 cases,69.7%),followed by asthma(17 cases,51.5%),infiltrative pneumonia(14 cases,42.4%),peripheral neuropathy(9 cases,27.3%),thrombosis formation(9 cases,27.3%).The mean absolute value of eosinophils in all patients was measured as(3.43±3.52)×109/L,with eight patients(24.2%)testing positive for antineutrophil cytoplasmic antibody(ANCA).Compared with ANCA-negative patients,ANCA-positive individuals exhibited significantly higher Birmingham Vasculitis Activity Score(BVAS)and eosinophil count,as well as a higher incidence rate of renal involvement(P<0.05).Glucocorticoid therapy was administered in thirty-two patients(97%),while biologics or tofacitinib were given to eleven patients(33.3%),among them six received tofacitinib treatment,of which five achieved disease remission.Conclusion EGPA exhibits a wide range of clinical manifestations,and ANCA-positive patients tend to exhibit higher disease activity levels.A multidisciplinary diagnosis and treatment system for EGPA should be established.

Objective:To analyze the abnormal results of health surveillance for workers exposed to dimethylformamide (DMF), and to provide reference for the formulation of relevant policies and standards.Methods:In April 2024, 11, 224 workers who participated in occupational health examinations in Jiangsu Province in 2023 were selected as the research subjects. Among them, 5, 615 people exposed to DMF were taken as the exposure group, and 5, 609 people not exposed to hepatotoxic chemicals were taken as the control group. By inquiring about related symptoms and combining with the occupational health examination of workers, the abnormal rates of blood pressure, blood routine, urine routine, electrocardiogram, liver function and B-ultrasonography of the survey subjects were statistically analyzed.Results:Compared with the control group, the abnormal detection rates of indicators such as blood pressure, blood routine, urine routine, and electrocardiogram were higher, and the difference was statistically significant P<0.05). The abnormal rates of various liver function indicators in the DMF exposure group were all higher than those in the control group. Among them, the abnormal rates of alanine aminotransferase, total protein, total bilirubin, and liver B-ultrasound in the exposure group were all higher than those in the control group, and the differences were statistically significant ( χ2=34.88, 42.49, 43.07, 55.28, P<0.001). Compared with the control group, the detected values of alanine aminotransferase, total protein and total bilirubin in the DMF exposure group were higher, and the difference was statistically significant ( F=5.367, 29.543, 37.766, P<0.05). In the DMF exposure group, the abnormal rates of liver function, electrocardiogram and liver B-ultrasound in men were much higher than those in women, and the differences were statistically significant ( χ2=185.05, 10.06, 141.94, P<0.001, P=0.002, P<0.001). Grouped by length of service, the abnormal detection rate of liver function was similar in each length of service segment, and the difference was not statistically significant ( χ2=0.34, P>0.05). The abnormal detection rate of electrocardiogram increased with the increase of length of service, among which it was the highest in the 10-20 years of service, and the difference was statistically significant ( χ2=7.26, P=0.026). The abnormal rate detected by liver B-ultrasound significantly increased with the increase of working years, and was the highest in the section of ≥20 years of working years. The difference was statistically significant ( χ2=44.15, P<0.001) . Conclusion:Occupational exposure to DMF can affect the health of workers, especially increasing the detection rate of abnormal liver function and liver B-ultrasound. It is very important to strengthen the occupational health monitoring of personnel exposed to DMF, improve the working environment, and pay attention to the chronic liver damage caused by DMF occupational exposure to workers.

Objective:To investigate the optical coherence tomography (OCT) imaging features of bullous pemphigoid (BP) and pemphigus.Methods:A total of 23 patients with BP and 18 with pemphigus diagnosed according to clinical manifestations, histopathological and immunological features were collected from Wuhan No.1 Hospital from January to June 2024. OCT imaging was performed in 41 patients to observe the blisters at the lesion sites and their anatomic locations (intraepidermal or subepidermal), intravesicular inflammatory cells and fibrin deposits, dilated vessels in the upper dermis, as well as skin adjacent to the lesions.Results:Among the 23 patients with BP and 18 patients with pemphigus (including 12 with pemphigus vulgaris and 6 with pemphigus foliaceus), there were 20 males and 21 females, and their ages at onset ranged from 20 to 89 years. OCT imaging of blisters in patients with BP showed subepidermal oval to round hyporeflective liquid-filled areas containing highly refractive inflammatory cells and fibrin deposits, with dilated vessels in the upper dermis, while OCT imaging of blisters in patients with pemphigus showed intraepidermal blisters with a few inflammatory cells; the OCT imaging features of both BP and pemphigus were similar to their corresponding histopathological features. The detection rates of intravesicular inflammatory cells and fibrin deposition were significantly higher in the patients with BP (82.61% [19/23], 60.87% [14/23], respectively) than in those with pemphigus (44.44% [8/18], 11.11% [2/18]; χ2 = 6.54, 10.51, P = 0.011, 0.001, respectively). In the OCT images of normal skin adjacent to blisters, subclinical fissures were detected in 17.39% (8/46) of patients with BP and 25.00% (9/36) of patients with pemphigus. Conclusion:OCT imaging could accurately locate the blisters and potential subclinical lesions in normal skin adjacent to blisters in patients with BP and pemphigus, which is helpful for the early auxiliary diagnosis of these two diseases.

Objective:To investigate the optical coherence tomography (OCT) imaging features of bullous pemphigoid (BP) and pemphigus.Methods:A total of 23 patients with BP and 18 with pemphigus diagnosed according to clinical manifestations, histopathological and immunological features were collected from Wuhan No.1 Hospital from January to June 2024. OCT imaging was performed in 41 patients to observe the blisters at the lesion sites and their anatomic locations (intraepidermal or subepidermal), intravesicular inflammatory cells and fibrin deposits, dilated vessels in the upper dermis, as well as skin adjacent to the lesions.Results:Among the 23 patients with BP and 18 patients with pemphigus (including 12 with pemphigus vulgaris and 6 with pemphigus foliaceus), there were 20 males and 21 females, and their ages at onset ranged from 20 to 89 years. OCT imaging of blisters in patients with BP showed subepidermal oval to round hyporeflective liquid-filled areas containing highly refractive inflammatory cells and fibrin deposits, with dilated vessels in the upper dermis, while OCT imaging of blisters in patients with pemphigus showed intraepidermal blisters with a few inflammatory cells; the OCT imaging features of both BP and pemphigus were similar to their corresponding histopathological features. The detection rates of intravesicular inflammatory cells and fibrin deposition were significantly higher in the patients with BP (82.61% [19/23], 60.87% [14/23], respectively) than in those with pemphigus (44.44% [8/18], 11.11% [2/18]; χ2 = 6.54, 10.51, P = 0.011, 0.001, respectively). In the OCT images of normal skin adjacent to blisters, subclinical fissures were detected in 17.39% (8/46) of patients with BP and 25.00% (9/36) of patients with pemphigus. Conclusion:OCT imaging could accurately locate the blisters and potential subclinical lesions in normal skin adjacent to blisters in patients with BP and pemphigus, which is helpful for the early auxiliary diagnosis of these two diseases.