Investigation on the risk of recurrent immune thrombocytopenia in children and establishment of a predictive model / 基础医学与临床

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.

Study on the diagnostic value of lymphocyte subpopulations combined with chemokines in children with immunologic thrombocytopenic purpura / 安徽医科大学学报

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.

Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017 / 中华流行病学杂志

Objective: To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou, China, 2011-2017. Methods: From March 2011 to February 2017, we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital. Through standard questionnaires and follow-up survey via telephone, we collected information regarding the demographic characteristics, medical history, clinical symptoms and both direct and indirect costs associated with influenza, of the patients. We then compared clinical characteristics and economic burden of influenza A/H1N1, A/H3N2, and B infections among children with ILI. Results: We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs. 791 (12.9%) of the swabs showed positive for influenza virus, including 88 (11.1%) subtype influenza A/H1N1, 288 (36.4%) subtype influenza A/H3N2, and 415(52.5%) type influenza B. The proportions of cough, rhinorrhea, wheezing, vomiting and convulsion in influenza-positive children were higher than those influenza-negative children. Except for the prevalence rates of cough (χ(2)=9.227, P=0.010), wheezing (χ(2)=7.273, P=0.026) and vomiting (χ(2)=8.163, P=0.017), other clinical symptoms appeared similar between the three viral subtypes. Among all the ILI children, the average total cost per episode of influenza was 688.4 Yuan (95%CI: 630.1-746.7) for influenza-negative children; 768.0 Yuan (95%CI: 686.8-849.3) for influenza-positive children and 738.3 Yuan (95%CI: 655.5-821.1) for influenza B. Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (χ(2)=7.237, P=0.028). Conclusion: Children infected influenza showed higher prevalence rates of cough, rhinorrhea, wheezing, vomiting and convulsion than those without influenza. Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.

Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017 / 中华流行病学杂志

Objective To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou,China,2011-2017.Methods From March 2011 to February 2017,we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital.Through standard questionnaires and follow-up survey via telephone,we collected information regarding the demographic characteristics,medical history,clinical symptoms and both direct and indirect costs associated with influenza,of the patients.We then compared clinical characteristics and economic burden of influenza A/H1N1,A/H3N2,and B infections among children with ILI.Results We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs.791 (12.9％) of the swabs showed positive for influenza virus,including 88 (11.1％) subtype influenza A/H1N1,288 (36.4％) subtype influenza A/H3N2,and 415 (52.5％) type influenza B.The proportions of cough,rhinorrhea,wheezing,vomiting and convulsion in influenza-positive children were higher than those influenza-negative children.Except for the prevalence rates of cough (x2=9.227,P=0.010),wheezing (x2=7.273,P=0.026) and vomiting (x2=8.163,P=0.017),other clinical symptoms appeared similar between the three viral subtypes.Among all the ILI children,the average total cost per episode of influenza was 688.4 Yuan (95％ CI:630.1-746.7) for influenza-negative children;768.0 Yuan (95％CI:686.8-849.3) for influenza-positive children and 738.3 Yuan (95％CI:655.5-821.1) for influenza B.Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (x2=7.237,P=0.028).Conclusion Children infected influenza showed higher prevalence rates of cough,rhinorrhea,wheezing,vomiting and convulsion than those without influenza.Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.

Effect of chemotherapy regimen CCLG-ALL-2008 on children with TEL/AML1 fusion gene positive of acute lymphoblastic leukemia / 临床儿科杂志

Objective To evaluate the predictive role of TEL/AML1 fusion gene in protocol CCLG-ALL-2008 and to identify relevant factors influencing the outcome of ALL with TEL/AML1 fusion gene. Methods Ninety-nine patients with ALL harboring TEL/AML1 fusion gene (positive) and 329 cases without any specific fusion genes (negative) at diagnosis of B-lineage ALL from June 2008 to December 2014 were enrolled and their clinical and biological features were analyzed. Following-up ended in October 2015, the survival status was calculated by K-M curve and prognostic factors were analyzed by COX model. Results There were no differences between the two groups in age, white blood cell at the diagnostic stage, and treatment responses at 4 time points, namely, prednisone good response on day 8, M3 status of BM on D15, and the minimal residual disease (MRD) more than 1.0×10-3 on day 33 and 12th week. During the follow-up period, the relapse rate was lower in the positive group than that in the negative group (14/99 vs 69/329), the mortality rate of the negative group was twice of that in the positive group (55/329 vs 8/99). The five-year overall survival (OS) rate, relapse-free survival (RFS) rate and event-free survival (EFS) rate of the positive group were (86.1 ± 4.9)%, (80.7 ± 5.1)% and (78.9 ± 5.1)%, respectively, and (79 ±2.8)%, (72± 3.1)%, and (69.6+ 3.1)% for the negative group as well. COX regression analysis indicated that relapse and MRD level at the 12th week were independent prognostic factors on OS, RFS, and EFS (P<0.05) for the two groups. Conclusions TEL/AML1 fusion gene could be regarded as a relatively good indicator of risks in ALL children treated by CCLG-ALL-2008 protocol. ALL patients with TEL/AML1 are recommended to receive more intensive therapy including hematopoietic stem cell transplantation when the patients were high level of MRD on the 12th week after treatment.

Pathogenesis and prenatal diagnosis of hereditary Glanzmann thrombasthenia / 临床儿科杂志

Objective To explore the gene sequencing and prenatal diagnosis of Glanzmann thrombasthenia (GT). Methods The blood samples were drawn from one case of phenotype GT pediatric patient, patient’s parents, and one normal control. The amniotic lfuid and cord blood from the fetus of patient’s mother were collected. When the fetus was born 2 days, the blood was drawn. The coagulation routine test and platelet aggregation test were performed. The expression of platelet membrane glycoprotein (GP) IIb and GPIIIa were tested by lfow cytometry. Microsatellite technology is used to determine whether fetal cord blood is contaminated with maternal cells. The expressed region and the junctional zone between exon and introns of GPIIb and GPIIIa were ampliifed by PCR technology from blood sample of patient, patient’s parents, and fetus’s cord and 2 days after birth. The PCR products were then subjected to DNA sequencing. Results Adenosine diphosphate (ADP) cannot induce the platelet aggregation in the patient. The max rate of the platelet aggregation in the fetus’s cord blood was half of the normal. However, the max aggregation rate induced by ADP in the blood sample of parents and fetus 2 days after birth were equal to normal. The mean lfuorescence intensity (MnX) of platelet membrane GPIIb and GPIIIa in the patient were 10%and nearly zero of the normal control, respectively, while those in the parents, the fetus’s cord blood and 2 days after birth were more than 90%and 30%to 50%of the normal control. The cast-off cells in amniotic lfuid and the DNA in cord blood analysis by microsatellite technology conifrmed that the amniotic lfuid and cord blood not contaminated by maternal cells. Gene analysis showed the heterozygosis mutation in exon6 A3829→C and exon9 G42186→A of the patient’s GPIIIa led to the amino acid heterozygosis mutation in GPIIIaHis281→Tyr and Cys400→Pro. These two mutations came from the father and the mother separately. However, there was only one heterozygosis mutation in exon9 G42186→A in the cast-off cells in amniotic lfuid, the fetus’s cord and blood 2 days after birth. Conclusion This GT patient have double heterozygosis mutation. The fetus has heterozygosis mutation conifrmed after birth.

Hypofibrinogenemia caused by long-term administration of hemocoagulase: three cases report and literature review / 中华血液学杂志

<p><b>OBJECTIVE</b>A first report of 3 patients who developed hypofibrinogenemia due to long-term administration of hemocoagulase.</p><p><b>METHODS</b>The clinical data of three patients with hypofibrinogenemia due to long-term administration of hemocoagulase were analyzed, and the related literature was reviewed.</p><p><b>RESULTS</b>Case 1, a two-year old girl, had liver traumatic rupture and then treated with massive transfusion and fibrinogen infusion in addition to intravenous recombinant factor VIIa (two times) and hemocoagulase (2 U/d). The liver wound bleeding was soon stopped. However, her plasma fibrinogen level decreased to 0.12 g/L after continuous administration of hemocoagulase for 18 days. Case 2, a three-year old boy, had liver traumatic rupture and was treated with surgical repair, and then received hemocoagulase (2 U/d). On the 8th day, a large amount of blood was found to exude from abdominal cavity drainage tube and indwelling venous catheter, and his fibrinogen dropped to 0.24 g/L. Case 3 was a 45 year-old man who underwent a total mandibular resection because of malignant tumor, and he was given hemocoagulase (4 U/d). A continuous blood oozing was noted from his operation incision, and his fibrinogen level decreased to 0.25 g/L. All the three patients'plasma fibrinogen levels and coagulation tests returned to normal ranges after discontinuation of hemocoagulase administration and supplement of fibrinogen, and the bleeding stopped in cases 2 and 3.</p><p><b>CONCLUSION</b>Long-term use of hemocoagulase could induce hypofibrinogenemia and severe bleeding.</p>

Clinical Efficacy of Mizolastine in the Treatment of Dermatographism / 药物流行病学杂志

Objective:To investigate the clinical efficacy of mizolastine in the treatment of dermatographism. Method:32 patients were randomly allocated to two groups.Their efficacy was compared with ketotifen.A two-period cross trial was adopted.Result:The clinical efficacy of mizolastine in the treatment of dermatographism corresponded to ke- totifen,the ADRs were markedly lower than ketotifen.Conclusion:Mizolastine is effective in the treatment of dermatogra- phism.

Clinical and biological characteristics in childhood acute myeloid leukemia with 8;21 translocation / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the clinical and biological characteristics of childhood acute myeloid leukemia(AML)with 8;21 translocation.</p><p><b>METHODS</b>A retrospective analysis including clinical information, cell morphology, chromosome, immunophenotype and molecular biology was performed on 41 cases of childhood t(8;21)AML. The control group included 19 cases of AML without t(8;21) translocation detected during the same period.</p><p><b>RESULTS</b>The 41 cases of t(8;21)AML accounted for 68.3% of 60 continuous childhood AML patients. Among them, classical t(8;21) translocation was seen in 29 cases; variant t(8;21) translocation, simple 8q-, near-tetraploidy characterized by the duplication of t(8;21) translocation each came into view in 2 cases; and cryptic t(8;21) translocation was seen in 6 cases. Thirty seven cases (80.4%) belonged to M2 subtype of AML. Most of them had the morphological changes such as the leukemia cells' indent nucleus with a light stain region of perinucleus, basophilic cytoplasm, differentiation with maturation, megaloblastoid changes and nuclear-cytoplasm imbalance; the high expression of CD13 antigen; and the AML1/ETO fusion transcript in 23 cases examined by reverse transcription-polymerase chain reaction (RT-PCR) assay, including 6 cases with normal karyotype. The difference in complete remission rate between t(8;21) positive patients group and t(8;21) negative patients group was not significant in statistics (82.4% vs 75%, P>0.05). However the difference in recurring rate of the leukemia was statistically significant (10.7% vs 41.7%, P<0.05).</p><p><b>CONCLUSION</b>t(8;21)AML is the most frequent type of childhood AML. It is predominantly associated with M2 subtype of AML and has unique morphological, immunological prognostic features .</p>