Objective To explore the diagnostic value of lymphocyte subpopulations combined with chemokines in children with immunologic thrombocytopenic purpura(ITP).Methods 132 children with proposed diagnosis of ITP were collected,and the children were divided into ITP and non-ITP groups according to the diagnostic results of ITP-related clinical diagnostic criteria.6 ml of peripheral venous blood was drawn,the levels of CD4+CD8+and CD3+were detected using flow cytometry,and the levels of chemokine(C-C motif)ligand 5(CCL5),Recombi-nant Chemokine(C-X-C Motif)Ligand 1(CXCL11),and monocyte chemotactic protein-1(MCP-1)were detec-ted using enzyme-linked immunosorbent assay,the blood platelet(PLT)was measured by a fully automated cell an-alyzer.The children were divided into ITP and non-ITP groups according to the clinical diagnostic criteria related to ITP.The lymphocyte subpopulations and chemokine levels of the two groups of children were compared,and the correlation between lymphocyte subpopulations and chemokine levels and PLT was analyzed.The ROC method was used to evaluate the diagnostic efficacy of individual and combined detection of each indicator for ITP.Results The levels of CD4+and CD3+in the ITP group were lower than those in the non ITP group(P<0.05),while the levels of CD8+were higher than those in the non ITP group(P<0.05).The levels of CCL5,CXCL11,and MCP-1 in the ITP group were higher than those in the non ITP group(P<0.05).The correlation analysis results showed that CD4+,CD3+and platelet count were positively correlated in the ITP group(P<0.05),while CD8+,CCL5,CXCL11,MCP-1 were negatively correlated with PLT(P<0.05).The ROC analysis results showed that the cut-off values of CD4+,CD8+,CD3+,CCL5,CXCL11,and MCP-1 for the diagnosis of ITP in children were 27.13%,24.02%,59.88%,41.02 ng/L,30.18 ng/L,and 188.27 ng/L,respectively.The AUC values were 0.893,0.880,0.629,0.801,0.892,and 0.751,respectively,The AUC of the parallel diagnosis(meaning that one or more of CD4+,CD3+was below the cut-off value and/or one or more of CD8+,CCL5,CXCL11,MCP-1 was above the cut-off value at the time of parallel testing)was 0.967,indicating that one or more of them was lower than the cut off value and/or one or more of them was higher than the cut off value when tested separately.Its diag-nostic efficacy was higher than that of each indicator tested separately(P<0.05).Conclusion There are signifi-cant differences in lymphocyte subpopulations and chemokines between pediatric ITP patients and non-ITP patients.CD4+,CD8+,CD3+,CCL5,CXCL11,and MCP-1 can be used for the diagnosis of pediatric ITP.Combined de-tection of various indicators can improve detection efficiency.

Objective To investigate the recurrence of immune thrombocytopenia(ITP)in children and to establish a predictive model.Methods A total of 288 children with ITP admitted to Children's Hospital of Wujiang District and Children's Hospital Affiliated to Suzhou University from January 2018 to April 2022 were collected.The factors potentially related to the recurrence of ITP in children were screened.The children in the model group were divided into 2 groups according to the presence or absence of recurrence and the indicators of the 2 groups were compared.After screening the potential influencing factors by LASSO regression and the independent influencing factors of relapse in children with ITP patients by Logstic regression analysis,we constructed a column-line graph model by using R language and validated it.Results A total of 37(18.47%)of 201 patients in the model group experienced relapse.The age,blood type,duration of disease before treatment,antecedent infections,bleeding,initial treatment regimen,antinuclear antibody titer,initial count and mean platelet volume,initial platelet distri-bution width,initial peripheral blood lymphocyte count and time length to effective platelet count after treatment were found in the recurrence group versus the non-recurrence group The difference was statistically significant(P＜0.05).The results of multifactorial logistic regression analysis performed on the basis of LASSO regression showed that blood type,duration of illness before treatment,antecedent infection,initial treatment regimen,ini-tial peripheral blood lymphocyte count,and time to effective platelet count after treatment were independent influ-ences on the conversion of cough variant asthma to classic asthma in children.Based on the results of the multifac-torial analysis,a column chart model for predicting ITP recurrence in children was developed in R.The results of the receiver operating characteristic(ROC)analysis showed that the area under curve(AUC)of the column chart model for predicting ITP recurrence in children in the modeling group was 0.867[95%CI(0.796,0.938)]with a sensitivity of 84.2%and a specificity of 73.1%,and that in the validation group,the AUC was 0.838[95%CI(0.765),0.911]with a sensitivity of 82.3%and a specificity of 78.4%,0.911)]sensitivity was 82.3%and specificity was 78.4%.The Bootstrap method was used to repeat the sampling 1000 times,and the validation group was used for validation.The results of the calibration curve showed that the prediction curves of the model group and the validation group were basically fitted with the standard curve,suggesting that the model prediction accuracy was high.The results of the decision curve analysis of the model group showed that the net benefit rate of patients was greater than zero when the probability threshold of the column line graph model of pre-dicting ITP recurrence in children was 0.15-0.75.Conclusions ITP recurrence in children is mainly affected by the patient's age,blood type,and pre-treatment course of the disease,and the column-line diagram model based on these factors has a high accuracy and differentiation for ITP recurrence in parenting children.

Objective:To analyze the effects of exposure to life events and social support levels during different stages of pregnancy on low birth weight in offspring.Methods:From 2021 to 2023, pregnant women in early pregnancy who were registered with health cards in Linping District, Hangzhou City, were recruited and followed up. The Life Events Scale for Pregnant Women (LESPW) and Social Support Rating Scale (SSRS) were used to evaluate the exposure to life events and social support levels of pregnant women in early, middle and late pregnancy, respectively. A generalized linear model was used to analyze the impact and critical period of exposure to prenatal life events and social support levels on the risk of low birth weight in offspring.Results:A total of 3 663 pregnant women with ages M ( Q1, Q3) of 29.18 (26.59, 32.21) years were included in this study. 116 cases (3.17%) of infants with low birth weight were delivered. Generalized linear model analysis showed no correlation between the level of social support in early, middle and late pregnancy and low birth weight in offspring (all P>0.05). The risk of low birth weight in offspring of pregnant women with high exposure to early pregnancy life events was 1.78 times higher than that of the low exposure group ( RR=1.78, 95% CI: 1.13-2.73, P=0.010), and there was no association in the middle and late stages of pregnancy (both P>0.05). Pregnant women with high exposure to early life events and low levels of social support had a 2.08-fold higher risk of low birth weight in their offspring compared to the low exposure group ( RR=2.08, 95% CI: 1.17-6.78, P=0.010), while this situation was not associated with high social support stratification. Conclusion:Exposure to life events during pregnancy has an early window effect on birth weight. Increased exposure to life events during early pregnancy is associated with a higher risk of low birth weight in offspring. This association is more pronounced in pregnant women with low social support.

Objective:To analyze the effects of exposure to life events and social support levels during different stages of pregnancy on low birth weight in offspring.Methods:From 2021 to 2023, pregnant women in early pregnancy who were registered with health cards in Linping District, Hangzhou City, were recruited and followed up. The Life Events Scale for Pregnant Women (LESPW) and Social Support Rating Scale (SSRS) were used to evaluate the exposure to life events and social support levels of pregnant women in early, middle and late pregnancy, respectively. A generalized linear model was used to analyze the impact and critical period of exposure to prenatal life events and social support levels on the risk of low birth weight in offspring.Results:A total of 3 663 pregnant women with ages M ( Q1, Q3) of 29.18 (26.59, 32.21) years were included in this study. 116 cases (3.17%) of infants with low birth weight were delivered. Generalized linear model analysis showed no correlation between the level of social support in early, middle and late pregnancy and low birth weight in offspring (all P>0.05). The risk of low birth weight in offspring of pregnant women with high exposure to early pregnancy life events was 1.78 times higher than that of the low exposure group ( RR=1.78, 95% CI: 1.13-2.73, P=0.010), and there was no association in the middle and late stages of pregnancy (both P>0.05). Pregnant women with high exposure to early life events and low levels of social support had a 2.08-fold higher risk of low birth weight in their offspring compared to the low exposure group ( RR=2.08, 95% CI: 1.17-6.78, P=0.010), while this situation was not associated with high social support stratification. Conclusion:Exposure to life events during pregnancy has an early window effect on birth weight. Increased exposure to life events during early pregnancy is associated with a higher risk of low birth weight in offspring. This association is more pronounced in pregnant women with low social support.

Background and objective Lacking of typical symptoms, more than 70% of patients with lung cancer are diagnosed as advanced-stage disease. Patients suffer from solid organs metastasis with different clinical features and prog-nosis. With development of new technology, more and more lung cancer patients are diagnosed with pancreatic metastasis. The aim of this study was to investigate clinicopathologic and survival difference by retrospective analysis among lung cancer patients with pancreatic metastases.Methods Of the patients with lung cancer diagnosed by pathology and thorough staging evaluation and treated at Beijing Cancer Hospital with long follow-up during July 1996 and June 2017, 35 cases had pancreatic metastases.Results There were 28 cases diagnosed as small cell lung cancer, 3 cases diagnosed as adenocarcinoma and 4 cases diagnosed as squamous cell carcinoma. There were 15 cases with pancreatic metastases in head of pancreas and 20 cases in body and tail of pancreas, 23 cases presented with isolated metastasis and 12 cases with multiple metastases. Pathological type was prognostic factor for lung cancer patients with pancreatic metastases.Conclusion Pancreatic metastases represents an uncommon site of extrathoracic spread of disease for part of patients with advanced lung cancer. Lung cancer with pancreatic metastases should be treated by combined therapy, especially by systemic chemotherapy. Pathological type was prognostic fac-tor for lung cancer patients with pancreatic metastases.

Objective To observe the efficacy and effect on cerebral vascular reserve and serum hs-CRP of Xueshuantong combined with butylphthalide in patients with acute cerebral infarction.Methods A total of 140 cases with ACI in Huzhou Central Hospital from August 2015 to July 2016 were divided into the observation group and the control group with 70 cases in each group, according to the order of single and double number.The control group was treated with routine western medicine while giving butylphthalide , and the observation group was given Xueshuantong on the basis of the control group.After two weeks of treatment, the efficacy and CVR, BHI and hs-CRP levels were observed.Results After treatment, the total effective rate of the observation group was 92.86%, and the control group was 81.43%, the difference was statistically significant (χ2 =4.080, P<0.05), there was significant differences of CVR, BHI between two groups (Fgroup =5.534, 4.608, P<0.05), the CVR and BHI increased gradually with time (Ftime =11.325, 9.432, P<0.05), the rised amplitude in observation group was higher than the control group (Finteraction =5.742, 5.016, P<0.05), there were significant differences in the levels of hs-CRP between two groups (Fgroup =7.421, P<0.05), and hs-CRP decreased gradually with time (Ftime =10.185, P<0.05), the decrease of observation group was larger than that of control group(Finteraction =4.824, P<0.05).Conclusion Xueshitong combined with butylphthalide in the treatment of ACI is effective , can better improve cerebral vascular reserve capacity and inhibition of inflammatory response, better than the single use of butylphthalide.

Objective To investigate the application and effects of the continuous improvement measures on pressure ulcer management .Methods Many methods were used such as collecting and analyzing the data of pressure ulcer status , conducting and applying corresponding improvement measures , optimizing nursing process , and analyzing the effect .Results With the continuous improvement measures , the assessment of hospital-acquired pressure ulcer was increased from 82.6% to 98.0%.The incidence of hospital-acquired pressure ulcer was decreased from 21.93% to 14.58%, and the difference was statistically significant (χ2 =5.44,P<0.05).Conclusions Studying the important factors of pressure ulcer problem , and optimizing nursing process could improve the incidence of hospital-acquired pressure ulcer .

Objective To explore the effect on immunologic function of gastric carcinoma patients after operation by transposition of a transverse colon segment as a gastric reservoir following total gastrectomy.Methods A prospective,randomized,double-blind clinical trial was performed.One hundred and sixty-seven gastric carcinoma patients were divided into control group and research group in terms of balanced random groups.We reconstructed digestive tract with conventional Schlatter esophagojejunostomy and Roux-enY esophagojejunostomy in control group,while we reconstructed digestive tract with transposition of a transverse colon segment as a gastric reservoir in rcsearch group.the changes of T cell subset,IL-2,immunologic function of red blood cell,acute inflammatory mediator were analyzed in the patients respectively at the first day before operation,at the first day after operation,at the ninth day after operation.Postoperative fatality rate was also detected in two groups.Results Compared with control group,The changes of T cell subset,IL-2 had no significant differences in research group at the first day after operation (P ＞ 0.05).chaplet Meanwhile,the changes of C3b receptor chaplet rate and immunocomplex receptor rate had no significant differences in rcscarch group compared with control group at the first day after operation (P ＞ 0.05).There were no obvious differences for acute inflammatory mediators between two groups at the first day after operation (P＞0.05).At the ninth day after operation,the levels of CD4+ (44.68 ±5.92)％ in control group were obviously lower than those (48.75 ± 6.24)％ in research group (P ＜ 0.05).However,the percentage of CD8 + T cells (27.21 ± 3.07) ％ in control group was significantly higher than that (24.26 ±2.39) ％ in research group (P ＜ 0.05).The levels of IL-2 in control group and research group were (1.49 ± 0.32) μg/L and (1.67 ± 0.35) μg/L,with obvious differences between two groups (P ＜ 0.05).At the ninth day after operation,C3b receptor chaplet rate (39.27 ± 6.88) ％ in research group was markedly higher than that (30.25 ± 6.65) ％ in control group (P ＜ 0.05).The levels of IL-6 in control group were (125.51 ± 18.24) pg/mL,while the levels of IL-6 in research group were(87.34 ± 12.88) pg/mL,with obvious differences (P ＜ 0.05).There was no significant difference for postoperative fatality rate between two groups (P ＞ 0.05).Conclusions The transposition of a transverse colon segment as a gastric reservoir is a safely new mode in the reconstruction of alimentary.It is positive to improve immunologic function for gastric carcinoma patients after operation.

Objective To investigate the characteristics and risk factors of anemia in renal transplant recipients over 60 years old.Methods Clinical data of one hundred and sixty-eight renal transplant recipients over 60 years old were retrospectively analyzed.Logistic regression analysis was used to determine the risk factors of anemia.Results In 168 cases of renal transplant recipients,the incidence of anemia was 45.2％(76/168).Forty cases were normocyte and normochromic,26 cases were microcytic hypochromic,10 cases were hemolytic anemia.In these anemic recipients,51 cases were short of erythropoietin (EPO),25 were EPO resistance.The incidence of malnutrition and cardia-cerebrovascular complication was higher in recipients with anemia than those without anemia (P＜0.01).The incidence of anemia in CsA+Aza+Pred treatment was 57.1％,which was significantly higher as compared to other three treatments (P＜0.01).Unconditional multivariate Logistic regression analysis revealed that male,creatinine level,acute reject reaction,delayed graft function (DGF) were the independent predictors of anemia,the corresponding OR values were 1.089,5.156,6.345,1.876.Conclusions Anemia is a common and serious complication in renal transplant recipients over 60 years old.Male,creatinine level,acute reject reaction,DGF are the independent risk factors of anemia in renal transplant recipients over 60 years old.

Objective: To try to find out the morbidity of elderly chronic pulmonary disease's malnutrition by means of MNA and analyze the consistency between traditionalindex and MNA score. Methods: According to the score of MNA,we divided the 143 elderly pulmonary disease patients into three groups: A group(malnutrition); B group(malnutrition risk);C group(well nourished).The records included anthropometry,biochemical markers,dietary intake as well as the occurrence rate of pneumonia and respiratory failure. Results: There were marked differences on anthropometry,biochemical markers,dietary intake and the occurrence rate of pneumonia and respiratory failure among three groups. And the dietary intake of all three groups did not reach the standard of normal people. Conclusion: MNA is a good method that can be used to evaluate the nutritional state in elderly pulmonary disease patients.