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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 analyze the distribution of the regulator of G protein signaling 2 (RGS2) gene C1114G polymorphism in children with vasovagal syncope (VVS) and the associated clinical classification groups, and to explore the association between RGS2 C1114G and VVS.@*Methods@#This was a prospective case-control study. A head-up tilt test (HUT) was performed in 300 children visiting Children's Hospital Affiliated to Shanghai Jiaotong University from August 2010 to December 2015 for unexplained syncope. A total of 150 children with positive HUT and a diagnosis of VVS were enrolled and assigned to the VVS group. The VVS group was further divided into 3 subgroups based on characteristics of the heart rate and blood pressure measured during the HUT. A total of 150 children with negative HUT were enrolled and assigned to the HUT-negative group. A total of 150 healthy children were enrolled as the normal control group for genetic polymorphism detection. The clinical characteristics of patients in the VVS group and the HUT-negative group were recorded. Peripheral blood samples of each case were collected. RGS2 C1114G polymorphism was evaluated using high-resolution melting curve and polymerase chain reaction together with gene sequencing. The genotype and allele frequency were analyzed and compared among different groups (VVS, HUT-negative, and normal control) and VVS subgroups. Comparisons among groups were performed using Chi-square test.@*Results@#Patients in the VVS group (48 males and 102 females, aged (10.1±3.2) years) were more frequently female (68.0% vs. 57.3%;χ2=5.090, P=0.024) compared with patients in the HUT-negative group (67 males and 83 females, aged (10.8±2.2) years). No significant difference was found regarding the distribution of the CC genotype, CG genotype and GG genotype among the VVS group (n=98, 65.3%; n=36, 24.0%; n=16, 10.7%), the HUT-negative group (n=112, 74.7%; n=28, 18.7%; n=10, 6.7%) and the normal control group (n=108, 72.0%; n=31, 20.7%; n=11, 7.3%) (χ2=3.632, P=0.458). There was no significant difference in the frequencies of C allele and G allele in the VVS group (n=232, 77.3%; n=68, 22.7%), the HUT-negative group (n=252, 84.0%; n=48,16.0%) and the normal control group (n=247, 82.3%; n=53, 17.7%) (χ2=4.659, P=0.097). The 150 children in the VVS group were further divided into the mixed-response subgroup (n=83), vasodepressor-response subgroup (n=42) and cardioinhibitory-response subgroup (n=25). The CC genotype, CG genotype and GG genotype in the mixed-response subgroup, the vasodepressor-response subgroup and the cardioinhibitory-response subgroup were (n=65, 78.3%; n=16, 19.3%; n=2, 2.4%), (n=20, 47.6%; n=11, 26.2%; n=11, 26.2%) and (n=13, 52.0%; n=9, 36.0%; n=3, 12.0%), respectively. The frequencies of C allele and G allele in the mixed-response subgroup, the vasodepressor-response subgroup, and the cardioinhibitory-response subgroup were (n=146, 88.0%; n=20, 12.0%), (n=51, 60.7%; n=33, 39.3%) and (n=35, 70.0%; n=15, 30.0%), respectively. The percentages of the GG genotype and G allele were significantly higher in the vasodepressor-response subgroup than the other two subgroups (χ2=21.698, 25.345, all P=0.000).@*Conclusions@#No significant association was found between RGS2 C1114G polymorphism and VVS in children. Due to the higher distribution of GG genotype and G allele in the vasopressor-response subgroup, RGS2 C1114G may be associated with the regulation of blood pressure during the onset of VVS in children.
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Objective To describe the status quo of influencing factors of resilience among caregivers of cancer patients, and to analyze the influence path. Methods A total of 407 caregivers of cancer patients in tertiary hospital in Xinjiang uygur autonomous region were recruited by cross-sectional survey method. Caregivers were investigated using the Connor-Davidson Resilience Scale, the Social Support Rating Scale, the Self-Efficacy Questionnaire, the Coping Modes Questionnaire, Positive and Negative Affect Schedule. Results The overall resilience score was (67.86 ± 11.36) points. Multiple linear regression analysis showed that caregivers′resilience was affected by subjective support,objective support, the self-efficacy, positive and negative coping modes, positive affect (P<0.01) and explained 44.9% of all the variation. subjective support, objective support and the self-efficacy directly and indirectly influenced resilience of caregivers of cancer patients. Conclusion Caregivers of cancer patient have a relatively high resilience level. subjective support and objective support were important factors.
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Objective To explore the moderating and mediating role of social support in the relationship between caregiver burden and Negative Affect in Caregivers of cancer patients. Methods A total of 407 caregivers of cancer patients in tertiary hospital in Xinjiang were recruited by cross-sectional survey method. Caregives were investigated using Caregiver Burden Scale for Cancer patients, Positive and Negative Affect Schedule, theSocialSupport Rating Scale. Results Social support mediated the relationships between caregiver burden andnegative effect, which accounted for 6.41％ of the total variance. The interactive effects of caregiver burden× social support on thenegative affect was significant(β=0.003, t=2.782, P<0.01). Conclusions Social support plays a mediatingand moderating role on the relationships between caregiver burden and negative effect.
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Objective To investigate the value of T2WI histogram analysis in differential diagnosis of glioblastoma multiform (GBM) from solitary metastasis.Methods Data of 103 patients with pathologically confirmed GBM (GBM group,n=57) and solitary brain metastasis (solitary brain metastasis group,n =46) were retrospectively reviewed.All patients underwent conventional MR scanning,including axial T1WI,T2WI,FLAIR and contrast-enhanced T1WI before surgery.The histogram metrics,including mean,standard deviation (SD),median,kurtosis and skewness were calculated from ROI,which were manually placed on the maximal section of the solid part of tumors on T2WI by using Image J software.ROCs were generated to evaluate differential diagnostic performance of the histogram metrics with significant difference between both groups.Results The values of mean,SD and median were significantly higher in GMB group than those in solitary brain metastasis group (P＜0.05).The areas under ROC curve of mean,SD and median was 0.772 (95％ CI [0.681,0.862],P＜0.001),0.719 (95％ CI [0.616,0.822],P＜0.001) and 0.767 (95％ CI [0.674,0.860],P＜0.001),respectively;and the diagnosis cutoff value of mean,SD and median was 509.575,58.844 and 550.500,respectively.The sensitivity of the three parameters was 0.719,0.702 and 0.719,and the specificity was 0.783,0.652,and 0.826,respectively.Conclusion The value of mean,SD and median of T2WI histogram analysis can be helpful to differentiating GBM and solitary brain metastasis,of which the mean value is the best for differential diagnosis.
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Objective To analyze the clinical features and risk factors of death in pediatric trauma,in order to provide preventing strategies and reduce mortality.Methods A retrospective study of 7936 traumatic children admitted to the emergency department of our hospital from April 2014 to March 2016 was conducted.We retrospectively summarized the clinical features and Logistic regression analysis was used to analyze the risk factors of death in children with trauma.Results Compared to females,male patients contributed higher percentages(1.73∶1).There were more migrant children(5535 cases) than local ones(2 401 cases)(χ2=14.314,P＜0.05).Children in infancy stage(2 024 cases)and toddler period(3 097 cases) were more than in the other periods.Limb[41.9%(3 324/7 936)] and skin injuries[38.5%(3 058 324/7 936)] were the most common.Children trauma causes varied with age,fall,tumble and traffic accidents were common causes of children trauma.Pediatric trauma score of surviving group(n=1933),death group(n=5),general ward group(n=1852) and ICU group(n=86) were 8.53± 2.17,3.17± 1.29,9.72± 1.25,5.23± 1.84,respectively.Shock decompensation,mechanical ventilation,Glasgow coma scale ≤7 and pediatric trauma score＜8 were the risk factors which caused the death of trauma.Conclusion Parents should improve the security sense,strengthen the care of children and obey the traffic rules to reduce the rate of children trauma.Clinicians should pay attention to shock decompensation,mechanical ventilation,Glasgow coma scale and pediatric trauma score in order to identify critically ill patients in early stage and improve the success rate of rescue.
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Objective To study the effects of propofol exposure during pregnancy on space cognitive and exploration abilities and expression of phosphorylated tau protein ( P-tau) and beta-amyloid protein[ Aβ(1-42) ] in hippocampus of the offspring. Methods Sprague-Dawley female (n=24) and male rats (n=8) of three months old were mated at the same cage at the ratio of 3:1. Pregnant rats were randomly divided into early group (group E), medium group (group M), late group (group L) and control group ( group C) , with 6 rats in each group. Groups E, M and L received propofol 80 mg · kg-1 · d-1 for 7 consecutive days. Propofol was replaced with equal volume of physiological saline in group C. Learning and memory of the 30-day offspring rats were assessed by using Morris water maze test. Then offspring rats were sacrificed to determine the expression of P-tau and Aβ(1-42) in the hippocampus by ELISA and immunohistochemistry. Results The learning and memory abilities were declined significantly in group E (51. 20±8. 11) s, group M (36. 00±6. 44) s and group L (47. 20±12. 30) s, as compared with group C (65. 60± 7. 23) s (all P<0. 05). The result of immunohistochemistry and ELISA showed that expression of Aβ(1-42) and P-tau in hippocampus was significantly higher in group M than in groups E, L and C[(immunohistochemistry: Aβ(1-42), (27. 38±5. 90) vs. (12. 65± 2. 08), (13. 79±3. 37), and (65. 60±7. 23); P-tau, (26. 35±5. 83) vs. (13. 65±3. 46), (14. 56±3. 82), and (8. 49±1. 20);ELISA:Aβ(1-42) , (88. 6±7. 43) vs. (71. 60±6. 79), (13. 79±3. 37), and (65. 80±6. 28);P-tau, (230. 13±8. 22) vs. (210. 42± 2.20), (210.95±1. 75), and (200. 65±1. 57)] (all P<0.05). Conclusion Multiple propofol injections may impair rat offspring’ s space cognitive abilities and exploration abilities, and the impairment is especially obvious in second trimester of pregnancy, which may be associated with over-expression of P-tau and Aβ(1-42) .
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Objective To evaluate the effectiveness of comprehensive lifestyle modification in the primary health care system on status of pre-chronic diseases in a conventional healthcare program.Methods Two hundred and twenty-nine adult volunteers in 5 conventional healthcare centers were divided into 4 groups:group of prehypertension(n=67),group of prediabetes(n=38),group of abnormity serum cholesterol(n=71)and group of osteopenia(n=53).A muhicomponent behavioral intervention including education,physical activity,dietary practice,cease smoke,calcium supplement and exposure to sunlight was conducted for 12 months.The main outcome of each group was blood pressure,blood glucose,serum cholesterol and bone mineral density.Results Over 12 months,compared with the status before intervention,participants in each group were statistically significantly improved,the mean net reduction in systolic BP/diastolic BP was 9.4 mm Hg/6.6 mm Hg(1 mm Hg=0.133 kPa,t=5.93/8.29.P＜0.05)in group of prehypertension;the reductions of blood glucose,serum cholesterol were 0.9 mmol/L(t=3.69,P＜0.05)and 0.5 mmol/L(t=4.09,P＜0.05)in group of prediabetes and group of abnormity serum cholesterol,and the increase of bone mineral density on lumbar spine was 0.015 g/cm2(t=2.03,P＜0.05)in group of osteopenia,Conclusions For chronic disease prevention,ater one year the comprehensive lifestyle intervention produced beneficial changes in diet,physical activity,and biochemical parameters.This type of intervention is a feasible option to prevent chronic disease and should be implemented in the primary health care system.
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Three hundred and ninety-five administrative staffs were randomly selected and provided health management to evaluate its effects in risk factors control of chronic diseases. At 1 year, the rate of people health knowledge and attitude were increased from 14.2% to 39.2%, 7.1% to 25.1%, P≤0.01 ; risk behavior exposure, including incorrect dietary intake, sedentary habit, alcohol consumption or smoking, reduced to some extent (P<0.05).
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Objective To understand the trend of lung cancer mortality of permanent residents in Beijing urban area caused by the influence of per capita tobacco consumption and air pollution.Methods Data of lung cancer mortality,air pollution and tobacco consumption from 1982 to 2005 was collected from published year books and Beijing cancer registration division.Trend analysis was applied to test significance of trend of lung cancer mortality of permanent resident in Beijing urban area.Distributed lag model was applied to determine the influence of per capita tobacco consumption and air pollution on lung cancer mortality by Eviews software package.Results Lung cancer mortality of permanent residents in Beijing urban area elevated from 19.74/100 000 in 1982 to 44.73/100 000 in 2005.In the distributed lag model for lung cancer mortality,with per capita tobacco consumption as independent variable,comprehensive index of air pollution,NO2 and PM10 were not statistical significant,while SO2 had statistical significance(P
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ObjectiveTo explore the application of new tec hn iques: pulmonary surfactant(PS), nasal continuous positive airway pressure (NCPA P) and the neonatal transportation on the morbidity and mortality of ventilated very low birth weight infant (VLBWI).MethodsSeventy three VL BWI ventilated because of respiratory failure ,recurrent apnea and cardiopulmo nary resuscitation were enrolled in this study. They were divided into two group s according to the use of new techniques, before and after. There were 32 cases during 1995～1998 in group A and 41cases during1999～2002 in group B. In group B, PS was used in 10 cases (24%); NCPAP in 12 cases (29%) after extubation, and transportation in 11 cases (27%).ResultsThe survival rate in group B were significantly improved (71% vs 39%, P
