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Objective:To establish a decision tree model of pediatric complicated appendicitis (CA) based on Pediatric Appendicitis Score (PAS) combined with inflammatory indicators, and to evaluate its clinical application efficacy in pediatrics.Methods:The clinical data of 544 children diagnosed with appendicitis in Children′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 was retrospectively analyzed. According to postoperative pathology, the children were divided into uncomplicated appendicitis group and CA group. The independent risk factors of CA were screened by univariate and multivariate logistic regression analysis, and these parameters were included to establish the decision tree model. The accuracy of the decision tree model was verified by receiver operating characteristic (ROC) curve.Results:Binary logistic regression analysis indicated that the PAS, C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) were identified as independent risk factors for complicated appendicitis in children (all P<0.05). PAS, CRP and NLR were included as covariables to construct the decision tree model and binary logistic regression model for predicting CA. The decision tree demonstrated an overall accuracy of 79.2% with a sensitivity of 86.7% and specificity of 71.9%, and achieved an area under curve (AUC) of 0.821(95% CI: 0.786-0.857). The binary logistic regression model had a sensitivity of 79.6% and specificity of 69.1%, with an overall accuracy of 75.1% and achieved an AUC of 0.808(95% CI: 0.770-0.845). Conclusions:The decision tree model based on PAS score combined with CRP, NLR is a simple, intuitive and effective tool , which can provide pediatric emergency physicians a reliable basis for diagnosis of pediatric CA.
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Objective:To retrospectively analyze the independent risk factors of complicated appendicitis(CA)in children under five years old and establish a clinical prediction model, and to evaluate the clinical application of this model.Methods:A retrospective analysis was performed on children under five years old who underwent appendectomy at Children′s Hospital of Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021.The children were divided into CA group and uncomplicated appendicitis group according to whether there was sign of perforation or gangrene in appendiceal tissue after operation.The differences in clinical features and preoperative laboratory test results between two groups were compared.The independent risk factors of CA were identified and a clinical prediction model was established.The clinical prediction model was verified by receiver operating characteristic curve.Results:A total of 140 children were enrolled in this study, including 84 cases in the CA group and 56 cases in uncomplicated appendicitis group.Univariate and binary Logistic regression analysis showed that the duration of symptoms>23.5 h( OR=6.650, 95% CI 2.469-17.912, P<0.05), abdominal muscle tension( OR=3.082, 95% CI 1.190-7.979, P<0.05) and C-reactive protein>41 mg/L ( OR=3.287, 95% CI 1.274-8.480, P<0.05) were independent risk factors for CA( P<0.05). The clinical prediction model of CA was constructed by the above mentioned three independent risk factors.The area under the receiver operating characteristic curve of the clinical prediction model was 0.881(95% CI 0.825-0.936), the sensitivity was 77.4%, the specificity was 87.5%, the positive predictive value was 91.3% and the negative predictive value was 70.0%. Conclusion:Acute appendicitis in children under five years old is more likely to progress to CA if the duration of symptoms>23.5 h, the level of C-reactive protein is increased, and the abdominal muscle tension is accompanied.The clinical prediction model of CA constructed by common clinical information in pediatric clinics has good prediction efficiency, which provides a simple and feasible reference method for clinicians to distinguish CA from uncomplicated appendicitis.
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Objective:To compare the complete blood count of children under 5 years old in outpatient department of pediatrics in general hospitals in Shanghai and Shigatse, and to explore the incidence and risk factors of anemia among children in different regions.Methods:Complete blood count of 19 863 children in outpatient department of pediatrics of Shanghai Ninth People′s Hospital in 2018 and 2 476 children in outpatient department of pediatrics of Shigatse People′s Hospital in 2018 were retrieved. The value of haemoglobin (HB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) were analyzed. The types, incidence and degree of anemia in different regions were compared. The information during pregnancies, supplementary foods, residence and educational level of mothers of anemic children in Shigatse area and Shanghai were collected.Results:The incidence of nutritional anemia in Tibetan children was higher than that in Shanghai, with mild to moderate anemia predominating in Tibetan area and mild anemia predominating in Shanghai. The incidence of anemia in Shigatse area was 41.32% (1 023/2 476), which was higher than that in Shanghai [14.35%(2 852/1 9 863)], and the difference was statistically significant ( P<0.05) .The incidence of mild anemia was 84.65% (866/1 023) in Shigatse and 94.81% (2 704/2 852) in Shanghai, with statistically significant difference ( P< 0.01). The incidence of moderate anemia in Shigatse was 14.08% (144/1 023) higher than that in Shanghai 5.05% (144/2 852), with statistically significant difference ( P<0.01). The incidence of severe anemia in Shigatse was 1.27% (13/1 023) higher than that in Shanghai 0.14% (4/2 852), with statistically significant difference ( P<0.01). Through the analysis of the questionnaires, being from pastoral areas, low educational level of mothers, poor nutrition during pregnancy, premature delivery, pure breastfeeding irregular maternity examinations and unreasonable supplementary food were related to nutritional anemia in ≤1 year-old babies. Conclusions:Nutritional iron deficiency anemia in the main type of anemia among children in both areas. Compared with Shanghai, the incidence of anemia of children in Tibet was higher, which may be caused by different feeding habits, cultural level and economic income between different regions. It is imperative to establish and improve the management of pregnant and lying-in women in Tibet, and provide scientific feeding and healthy lifestyle.
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Objective@#To compare the positive rate of microbiological examination in different clinical specimens, and to provide reliable basis for improving the quality of microbiological examination and management of nosocomial infection.@*Methods@#A total of 2 028 bacterial culture specimens were collected from the hospitalized patients in the Second People's Hospital of Jinanfrom March 2016 to February 2018.The samples were examined by Micro Scan autoSCAN4 automatic bacteriological identification analyzer.Strictly according to the specification of the standard operation, the positive rates of microbial testingof all kinds of clinical specimens were statistically analyzed.@*Results@#The positive rate of microbiological examination in 2 028 clinical specimens was 44.33%.The positive rate of microbiological examination in sputum was the highest(58.96%), followed by ophthalmic secretion(40.64%), eye contents(37.96%), urine(34.55%), blood(21.11%).@*Conclusion@#The positive rate of microbiological examination is different in different clinical specimens.The epidemiological situation of nosocomial infection can be understood by analyzing the microbiological examination of different clinical specimens in clinic.In order to provide a reliable basis for clinical prevention and treatment of nosocomial infection, and to further improve the positive rate of clinical microbiological examination, we should actively carry out improvement countermeasures against its influencing factors.
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Objective To explore the expression of protease activated receptors (PARs) on human monocytes. Methods Flow cytometry and RT - PCR was used to detect the expressions of PARs on human monocytes that purified by MACS. Results FACS analysis showed that monocytes expressed PAR - 1 , PAR - 3 , PAR - 4, but not PAR - 2.RT - PCR revealed that monocytes expressed PAR - 1 and PAR -3, but not PAR -2 and PAR -4 mRNA. Conclusion PARs is expressed on human monocyte cells,which may facilitate further investigation of the potential functions of PARs on monocytes.