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 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 explore the association between the intake and changes in various types of food and the changes in blood pressure in patients with mild to moderate hypertension.Methods:Mild to moderate hypertension participants with complete baseline and outcome data were included from DECIDE-Diet study, a multicenter, randomized controlled trial. Dietary records and blood pressure measurements at both 7-day run-in (baseline) and 28-day intervention phases were collected for enrolled participants. Blood pressure change was defined as the difference between blood pressure at the end of trial and the baseline blood pressure. Baseline intake of food was the average daily intake during the run-in period, and the intake increment was defined as the difference between the average intake during the trial period and the average intake during the run-in period. After adjusting for age, sex, study center, intervention groups, baseline body mass index (kg/m 2), antihypertension medication use, and baseline total calorie intake, a linear regression model was used to analyze the associations of the before-after-intervention change in blood pressure with baseline intake and intake increment of foods. Results:A total of 258 patients with mild to moderate hypertension were included, including 133 males, aged (56.5±9.9) years. (1) After adjusting for confounding factors, there was no significant association between baseline intake of food and baseline blood pressure (all P>0.05). The blood pressure change was negatively associated with baseline intakes of tubers, vegetables, and vegetable oils but positively with baseline intake of meats; and was negatively associated with intake increment of whole grains and fish (all P<0.05). (2) The multiple linear regression analysis showed that baseline intake of vegetables ( β=-0.021, P=0.004), vegetable oils ( β=-0.260, P=0.002), and increment in intake of fish ( β=-0.128, P=0.026) were all significantly associated with changes in systolic blood pressure; baseline intake of vegetables ( β=-0.017, P=0.002), vegetable oils ( β=-0.182, P=0.001), dairy products ( β=0.021, P=0.022), and increment in intake of fish ( β=-0.092, P=0.010) were all significantly associated with changes in diastolic blood pressure. Conclusion:Increasing the intake of whole grains, vegetables, vegetable oils, and fish and decreasing the intake of meat may be beneficial for blood pressure control in patients with mild to moderate hypertension.

Objective To observe the value of B1 corrected T1 mapping for distinguishing pathological types and differentiation degrees of lung cancers.Methods A total of 74 lesions in 65 patients with lung cancers were prospectively enrolled,including 49 poorly differentiated lesions and 25 moderately or well differentiated ones,i.e.42 adenocarcinomas,14 squamous cell carcinomas and 18 small cell lung cancers(all poorly differentiated).B1 corrected T1 mapping was performed,ROI(ROI1 and ROI2)were delineated using 2 methods,and T1 values of different pathological types and differentiation degrees lung cancers were compared.The receiver operating characteristic(ROC)curves were drawn,and the areas under the curve(AUC)were calculated.Results Significant differences of T1 values were found among different pathological types of lung cancer(all P＜0.05),as well as between small cell lung cancer and the rest 2 types of lung cancer(both P＜0.05).There were significant differences of T1 values between poorly differentiated and moderately well differentiated lung cancer(squamous cell carcinoma+adenocarcinoma)(both P＜0.05).Taken ROI1 T1 value=1 524.21 ms as the cut-off value,the AUC of T1 value for distinguishing poorly differentiated and moderately well differentiated lung cancer(squamous cell carcinoma+adenocarcinoma)was 0.698,with sensitivity of 64.50％and specificity of 76.00％.Taken ROI2 T1 value=1 630.68 ms as the cut-off value,the AUC of T1 value was 0.676,with sensitivity of 54.80％and specificity of 80.00％.Conclusion B1 corrected T1 mapping was helpful for distinguishing pathological types and differentiation degrees of lung cancers.

Objective:To evaluate myocardial microcirculation perfusion with myocardial contrast echocardiography (MCE) in patients with acute myocardial infarction after percutaneous coronary intervention (PCI), and to explore the prognostic value of different types of myocardial microcirculation perfusion.Methods:This is a prospective cohort study. Patients with acute myocardial infarction who underwent successful PCI in Nanfang Hospital of Southern Medical University and Kanghua Hospital of Dongguan City from October 2019 to June 2021 were selected. All the enrolled patients completed MCE examination within 72 hours after PCI. According to the examination results, the patients were divided into normal microcirculation perfusion group, delayed microcirculation perfusion group, and blocked microcirculation perfusion group. Adverse cardiovascular events including all-cause death, cardiovascular death, and angina re-hospitalization were followed up, and left ventricular ejection fraction (LVEF) review results were collected at six months to one year after surgery. Kaplan-Meier survival curve was used to investigate the difference in the incidence of adverse cardiovascular events in different myocardial perfusion groups, and Cox regression analysis was used to evaluate the effect of myocardial perfusion on adverse cardiovascular events.Results:A total of 113 patients with acute myocardial infarction were included, aged (56.3±11.5) years, with 88(78%) males. There were 31 cases in the normal microcirculation perfusion group, 43 cases in the delayed microcirculation perfusion group and 39 cases in the blocked microcirculation perfusion group. LVEF was reviewed in 49 patients, and LVEF in the delayed microcirculation perfusion group was significantly improved compared with baseline at follow-up ((63.3±1.2) % vs. (58.6±1.8) %, P=0.043), and there was no statistically significant difference between the other two groups (all P>0.05). The median follow-up time was 473 days, during follow-up period 30 adverse cardiovascular events occurred. Kaplan-Meier survival curve analysis showed that there was a statistically significant difference in the incidence of adverse cardiovascular events among the three groups ( Plog-rank=0.029). Cox regression analysis showed that abnormal microcirculation perfusion (defined as delayed and blocked microcirculation perfusion) was an independent predictor of adverse cardiovascular events in patients with acute myocardial infarction after PCI ( HR=1.90, 95% CI1.16-3.12, P=0.011). Conclusions:Microcirculatory perfusion decrease or lost is common in patients with acute myocardial infarction after PCI. Timely restoration of blood flow reconstruction can save heart function when microcirculatory perfusion decreases. Microcirculatory perfusion is a predictor of adverse cardiovascular events in patients with acute myocardial infarction, and patients with poor myocardial perfusion are more likely to experience adverse cardiovascular events.

OBJECTIVE To assess the efficacy and safety of different treatment modalities for moderate to severe Henoch- Schönlein purpura nephritis （HSPN）. METHODS Literature searches were conducted in the CNKI， VIP， Wanfang Data， SinoMed， PubMed， OVID， Web of Science， Embase， and the Cochrane Library to collect randomized controlled trials （RCTs） and cohort studies on the treatment of moderate to severe HSPN with 12 intervention measures： monotherapy with glucocorticoid （GC）， as well as cyclophosphamide， mycophenolate mofetil （MMF）， Tripterygium wilfordii multiglucoside （TWM）， leflunomide， mizoribine， tacrolimus， cyclosporin A， hemoperfusion， tonsillectomy combined with GC， and double filtration plasmapheresis （DFPP） combined with GC and cyclophosphamide or mycophenolate mofetil. The search period was from the inception of the databases to March 2024. After literature screening， data extraction， and quality assessment， a network meta- analysis was performed using Stata 16.0 software. RESULTS A total of 28 articles were included， with 14 RCTs and 14 cohort studies， involving 1 746 patients. The network meta-analysis results showed the combination of tacrolimus and GC had the highest probability of being the best in overall remission rate， followed by the combination of TWM and GC， and DFPP combined with GC and MMF. The combination of leflunomide and GC had the highest probability of being the best in complete remission rate， followed by the combination of mizoribine and GC， and DFPP combined with GC and cyclophosphamide. The combination of mizoribine and GC had the highest probability of being the best in terms of reducing 24-hour urinary protein quantification， followed by DFPP combined with GC and MMF， and the combination of leflunomide and GC. Moreover， the combination of tacrolimus and GC had the highest probability of being the best in safety， followed by the combination of cyclosporin A and GC， and the combination of leflunomide and GC. CONCLUSIONS Compared to other treatment methods， the combination therapy of tacrolimus and GC shows better efficacy and safety in the treatment of moderate to severe HSPN.

Objective To construction of discharge readiness assessment index for patients with percutaneous transhepatic biliary drainage.Methods Based on the framework of the Meleis's transitions theory,the relevant literature was consulted,the semi-structured interview and group discussion were implemented,and the framework of the assessment index system for discharge readiness of patients with percutaneous transhepatic biliary drainage was initially constructed.Then,two rounds of Delphi expert consultations were conducted.The weight of each indicator was set by Analytic Hierarchy Process.Results The effective recovery of 2 rounds of expert consultations were both 100％.The authority coefficients were 0.964 and 0.972,The Kendall harmony coefficients were 0.240 and 0.228(P＜0.001).The final discharge readiness assessment index system for patients with percutaneous transhepatic biliary drainage was established,including 4 first-level indicators and 35 second-level indicators.Conclusion The discharge readiness assessment index system for patients with percutaneous transhepatic biliary drainage was scientific and reliable,which can provide references for the evaluation of discharge readiness for patients with percutaneous transhepatic biliary drainage.

Intraoperative hypotension is closely associated with postoperative poor prognosis.Machine learning hypotension predictive index(HPI)based on invasive and non-invasive blood pressure monitoring can predict hypotension in non-cardiac and cardiac surgery,which makes blood pressure manage-ment from passive processing to preventive active control.Hemodynamic management based on HPI reduces the occurrence of hypotension in surgery.In this artical,the introduction of HPI,the application of HPI in-vasive and non-invasive blood pressure monitoring in surgery,and the limitations of HPI are reviewed.

Objective To compare the value of stack-of-stars-volumetric interpolated breath-hold examination(Star-VIBE)and T1-volumetric interpolated breath-hold examination(T1-VIBE)MRI for displaying peripheral lung cancer.Methods Fifty-two patients with 56 peripheral lung cancer were prospectively enrolled,and chest Star-VIBE and T1-VIBE MRI were acquired.The morphological features were observed,and the subjective scores were recorded.The maximum diameter,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of lesions were measured based on Star-VIBE and T1-VIBE MRI,respectively.Taken CT as the references,the value of Star-VIBE and T1-VIBE MRI for displaying peripheral lung cancer were compared.Results Star-VIBE MRI had higher scores for displaying spiculation sign,lobulation sign,pleural depression sign and halo sign than T1-VIBE(both P＜0.05).CNR and SNR of Star-VIBE MRI were significantly higher than those of T1-VIBE(both P＜0.001).No significant difference of the maximum diameter of lesions measured based on Star-VIBE and T1-VIBE MRI compared with CT was found,nor between Star-VIBE and T1-VIBE MRI(all P＞0.05).Conclusion Star-VIBE MRI had better value for displaying peripheral lung cancer than T1-VIBE.

Objective To investigate the mechanism of Chaihuang Qingyi Huoxue Granules(Bupleuri Radix,unprocessed Rhei Radix et Rhizoma,Paeoniae Radix Rubra,Paeoniae Radix Alba,Cortex Magnoliae Officinalis,etc.)on rats with severe acute pancreatitis(SAP)based on the renin-Ang-Ⅰ otensin system(RAS).Methods Sixty-four SD rats were randomly divided into four groups:sham operation group,model group,Chaihuang Qingyi Huoxue Granules group(4.42 g·kg-1)and Captopril group(5 mg·kg-1).Each group was further divided into 12-hour and 24-hour subgroups,with 8 rats in each group.SAP rat model was replicated by retrograde injection of 3.5％sodium taurocholate into the biliopancreatic duct.The Captopril group was intraperitoneally injected with Captopril(5 mg·kg-1),and the Chaihuang Qingyi Huoxue Granules group was given intragastric administration,once every 6 hours.The serum amylase(AMY)activity was detected by biochemical method at 12 hours and 24 hours after operation.The pathological changes of pancreatic tissue were observed by HE staining.Serum aldosterone(ALD)content was detected by chemiluminescence.Serum Renin,angiotensin converting enzyme(ACE)and angiotensin Ⅱ(Ang-Ⅱ)were detected by ELISA.The expression of AT1R protein in pancreatic tissue was detected by Western Blot.Results In the same subgroup at 12 and 24 hours,compared with the sham operation group,the serum AMY activity of rats in the model group was significantly increased(P<0.05),the pathological score of pancreatic tissue was significantly increased(P<0.05),the levels of serum ALD,Renin,Ang-Ⅱ and ACE were significantly increased(P<0.05),and the expression of AT1R protein in pancreatic tissue was significantly up-regulated(P<0.05).Compared with the model group,the serum AMY activity of rats in Chaihuang Qingyi Huoxue Granules group and Captopril group was significantly decreased(P<0.05),the pathological score of pancreatic tissue was significantly decreased(P<0.05),the levels of serum ALD,Renin,Ang-Ⅱ and ACE were significantly decreased(P<0.05),and the expression of AT1R protein in pancreatic tissue was significantly down-regulated(P<0.05).Compared with the Captopril group,the serum AMY of the rats in the Chaihuang Qingyi Huoxue Granules group was significantly decreased(P<0.05),the pathological score of pancreatic tissue was significantly decreased(P<0.05),and the serum ALD,Renin,Ang-Ⅱ and ACE levels were significantly decreased(P<0.05).Conclusion Chaihuang Qingyi Huoxue Granules may inhibit the production of Renin and ALD by down-regulating the expression of ACE-Ang-Ⅱ-AT1R classical axis,thus exerting a protective effect on SAP rats.