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Objective To explore the mechanism of the effect of itraconazole ethanolamine tablets on the CD40/CD40L axis in children with idiopathic thrombocytopenic purpura （ITP）. Methods 80 children with ITP were selected as the study subjects. They were divided into a control group （n = 40） and a study group （n = 40） using a digital random table method. The control group was treated with cyclosporine, while the study group was treated with itraconazole ethanolamine tablets. Both groups were treated continuously for 3 months. Compare the clinical efficacy of two groups of patients T lymphocyte subpopulation levels ［CD3+ CD4+ and CD4+/CD8+, as well as adverse reactions. Detect CD40 on the surface of lymphocyte membrane and platelet membrane in two groups of patients CD40L level, plasma sCD40 and sCD40L levels were detected using ELISA. Results The total effective rate of the study group （92.50%） was significantly higher than that of the control group （75.00%） （P < 0.05）. CD3+ CD4+, CD4+/CD8+, The expression levels of sCD40 in plasma were higher than before treatment, CD8+ and peripheral blood CD19+ CD40+ The expression levels of CD3+, CD40L+ cells, and plasma sCD40L were lower than before treatment; Research group CD3+ CD4+, CD4+/CD8+, The expression level of sCD40 in plasma was higher than that in the control group, CD8+, And peripheral blood CD19+ CD40+ The expression levels of CD3+ CD40L+ cells and plasma sCD40L were lower than those of the control group （P < 0.05）. The CD40L+ cells on the surface of peripheral blood platelet membranes after two treatment groups were lower than before treatment; The CD40+ on the surface of peripheral blood platelet membrane in the study group was higher than that in the control group, CD40L+ cells were lower than those in the control group （P < 0.05）. The total adverse rate of the study group （15.00%） was lower than that of the control group （22.50%）, but there was no significant difference between the two groups （P > 0.05）. Conclusion The treatment of ITP in children with eltrombopag olamine tablets has good clinical efficacy, regulates the level of T lymphocyte subsets, and is safe. [ABSTRACT FROM AUTHOR]

A 48-year-old male presented with purplish erythema on his back lor over 4 months, involving the face and muscle pain for 2 months. Physical examination revealed grade IV - strength in the neck muscles and grade IV + strength in the left upper arm. Scattered purplish-red patches and scales on the face, upper arms and trunk, and Gottron's sign on both knees. Laboratory tests showed ANA was 1 : 320 (nucleolar and cytoplasmic speckle pattern), anti-dsDNA > 300.00 IU/mL, anti-Ul-nuclear ribonucleoprotein/ smithantibody was positive (+), and anti-ribosomal P protein antibody was positive (2 +). Skin lesion histopathology revealed mild thickening of the epidermal layer, focal liquefaction of basal cells, moderate perivascular lymphocyte infiltration, and mucin deposition which was positive for alcian blue staining. A muscle biopsy showed inflammatory myopathy changes. During hospitalization, the patient developed severe and refractory thrombocytopenia with positive platelet-specific antibodies. The diagnosis of dermatomyositis associated with immune thrombocytopenia was made. Patient was treated with intravenous immunoglobulin and symptom improvement. After four months of follow-up, the patient's platelets and other laboratory indicators returned. [ABSTRACT FROM AUTHOR]

MicroRNA (miRNA) is a kind of small non-coding single stranded RNA that can participate in multiple biological processes. It also plays an important role in regulating the immune function of the body. Immune thrombocytopenia (ITP) is an autoimmune disease, whose cause and deterioration are closely related to miRNA regulates immune function of CD4+T cells subsets. In ITP patients, different expression of miRNA can affect the immune function of CD4+T cells subsets, which causes not only unbalanced expression of Th1/Th2, Th17/Treg and excessive differentiation of TFH, but also abnormal cytokine secretion furthermore. This paper summarizes the unbalanced mechanism of miRNA regulating immune function of CD4+T cells subsets in ITP, so as to provide inspiration for exploring the immunology and immunotherapy of ITP. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the curative effect of Helicobacter pylori (Hp) eradication therapy on idiopathic thrombocytopenic purpura (ITP) in children. Methods The randomized controlled trials of the curative effect of Hp eradication therapy on ITP in children were searched by computer in PubMed, Embase, Cochrane database of randomized controlled trials and Wanfang medical database. The retrieval time was from the establishment of the databases to August 2022. Statistical analyses were performed by using RevMan5.4 software and Stata12.0 software. Results A total of seven randomized controlled trials regarding 315 pediatric patients were included in this study. Compared with immunotherapy alone, Hp eradication therapy combined with immunotherapy could obviously improve the overall remission rate and complete remission rate, and reduce the recurrence rate after treatment (odds ratio=2.87,3.27,0.24,95% confidence interval: 1.60-5.13,2.01-5.32,0.11-0.53,P=0.000 40,＜0.000 01,0.000 30. Conclusion Hp eradication therapy has a beneficial effect on the clinical remission and relapse prevention of ITP in children. However, considering the limited quality of current research evidence, further large-scale and high-quality studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective To study the mechanism of the intervention of total flavonoids from Zhongjiefeng (sarcandra[twig and leaf]) on immune thrombocytopenia (ITP) using metabolomics techniques. Methods Using Excel random function, 48 male SD rats were randomly divided into the normal control group, the model group, the total flavonoids from Zhongjiefeng low-, medium-, and high-dose groups, and the prednisolone acetate group, with 8 rats in each group. Except for the normal control group, rats in other groups were injected intraperitoneally with rabbit anti-rat platelet serum (5 mL/kg) on days 1, 3, 4, 6, 7, and 8 to replicate an ITP rat model. Rats in the normal control group were injected intraperitoneally with an equal volume of physiological saline. Drug intervention was given on the modeling day once a day. The total flavonoids from Zhongjiefeng low-, medium-, and high-dose groups were gavaged with 31.5, 63.0, and 94.5 mg/kg of total flavonoids from Zhongjiefeng, respectively. The prednisolone acetate group was injected intraperitoneally with 10.0 mg/kg of prednisolone acetate. On days 0, 3, 6, and 9, the number of peripheral platelets in each group of rats was dynamically detected. On day 10, the spleen mass was measured and the spleen index was calculated. Screening and identification of differential metabolites in the spleen of rats in each group were carried out using ultra-high-performance liquid chromatography coupled with four-stage rod time-of-flight mass spectrometry technology and multivariate statistical analysis, and pathway enrichment analysis was conducted. Results Compared with the normal control group, the model group showed a decrease in peripheral blood platelets on days 6 and 9, an increase in spleen mass, and an increase in spleen index(P<0.05). Compared with the model group, the number of peripheral platelets on day 6 and 9 of the total flavonoids from Zhongjiefeng low-, medium-, and high-dose groups were increased, the spleen mass of the total flavonoids from Zhongjiefeng high-dose group was decreased, and the spleen indexes of the total flavonoids from Zhongjiefeng medium- and high-dose groups were decreased (P<0.05). Through metabolomics analysis of the spleen, 24 biomarkers related to ITP were identified. Of these, 21 were reduced in the total flavonoids from Zhongjiefeng high-dose group, which were mainly involved in linoleic acid metabolism, cysteine and methionine metabolism, and glycerol phospholipid metabolism. Conclusion The total flavonoids from Zhongjiefeng may restore the normal regulatory ability of the immune system by regulating spleen linoleic acid metabolism, cysteine and methionine metabolism, and glycerol phospholipid metabolism, in order to inhibit excessive platelet destruction and exert a therapeutic effect on ITP. [ABSTRACT FROM AUTHOR]

Objective To investigate the expression of interleukin-37 (IL-37), vascular endothelial growth factor A (VEGFA), and transforming growth factor-β1 (TGF-β1) in children with primary immune thrombocytopenia (ITP) and their correlation with T cells. Methods A retrospective analysis was conducted on 45 children with ITP (ITP group) who were admitted to Handan Central Hospital from January 2020 to April 2022, and 30 healthy children who underwent physical examination during the same period were included as the healthy control group. The mRNA expression levels of IL-37, VEGFA, and TGF-β1 and the levels of regulatory T cells (Treg) and helper T cells 17 (Th17) were measured before and after treatment, and the correlation between the mRNA expression levels of IL-37, VEGFA, and TGF-β1 and the levels of Treg, Th17, and Treg/Th17 ratio were analyzed. Results Compared with the healthy control group, the ITP group had a significantly higher mRNA expression level of IL-37 and a significantly higher level of Th17 before and after treatment, as well as significantly lower mRNA expression levels of VEGFA and TGF-β1 and significantly lower levels of Treg and Treg/Th17 ratio (P<0.05). After treatment, the ITP group had significant reductions in the mRNA expression level of IL-37 and the level of Th17 and significant increases in the mRNA expression levels of VEGFA and TGF-β1 and the levels of Treg and Treg/Th17 ratio (P<0.05). Correlation analysis showed that in the ITP group, the mRNA expression levels of IL-37 and TGF-β1 were negatively correlated with the levels of Treg and Treg/Th17 ratio (P<0.05) and were positively correlated with the level of Th17 (P<0.05) before and after treatment; the mRNA expression level of VEGFA was positively correlated with the levels of Treg and Treg/Th17 ratio (P<0.05) and was negatively correlated with the Th17 level (P<0.05) before and after treatment. Conclusions Abnormal expression levels of IL-37, VEGFA, and TGF-β1 may be observed in children with ITP, which is significantly associated with the imbalance of Treg/Th17 ratio. It is speculated that the cytokines such as IL-37, VEGFA, and TGF-β1 may be involved in the development and progression of ITP or may become important potential targets for the treatment of children with ITP. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of dimethyl fumarate （DMF） on primary immune thrombocytopenia （ITP） by regulating the polarization of macrophages. Methods: The BALB/c mice were divided into control group, ITP group, DMF low-dose group and DMF high-dose group, each with 15 mice. Except for the control group, the other three groups of mice were all constructed with ITP models. Mice in low-dose DMF group and high-dose DMF group were given 10 mg/kg and 20 mg/kg DMF by gavage, once a day for 14 consecutive days. The automatic blood cell analyzer was used to detect the levels of peripheral blood platelets （PLT）, red blood cells （RBC）, white blood cells （WBC） and hemoglobin （Hb） in mice; ELISA method was used to detect the levels of serum IFN-γ, IL-2, IL-4, IL-10, IL-17 and TGF-β1 in mice. Electronic balance was used to weight mouse body weight, spleen and thymus, and organ index was calculated; HE staining was used to observe the number of megakaryocytes in mouse spleen tissue and bone marrow tissues; Immunofluorescence staining was used to detect the polarization of macrophages in mouse spleen tissues; Flow cytometry was used to determine the polarization of macrophages in the peripheral blood of mice. Results: After the modeling started, the number of peripheral blood platelets of mice decreased significantly compared with that of control mice （P<0.05）, indicating that the modeling was successful. After modeling, compared with control group, the PLT, RBC and Hb of ITP group were decreased, WBC was increased （P<0.05）, the serum levels of IFN-γ, IL-2 and IL-17 were increased, and TGF-β1, IL-4 and IL-10 were all decreased （P< 0.05）, the spleen index was increased （P<0.05）, the number of megakaryocytes in spleen and bone marrow were increased （P<0.05）, the positive expression rate of M1 macrophage marker CD68+CD86+ in spleen tissue was increased, and the positive expression rate of M2 macrophage marker CD68+CD206+ was decreased （P<0.05）, the proportion of F4/80+CD86+ labeled cells in peripheral blood was increased, and the proportion of F4/80+CD206+ labeled cells was decreased （P< 0.05）. Compared with ITP group, the PLT of the mice in the DMF low-dose group was increased, and the WBC was decreased （P<0.05）, the PLT, RBC and Hb of DMF highdose group mice were increased, while the WBC was decreased （P<0.05）, the serum levels of IFN-γ, IL-2 and IL-17 in DMF lowand high-dose groups were all decreased, TGF-β1, IL-4 and IL-10 were all increased （P<0.05）, spleen index was decreased （P< 0.05）, the number of megakaryocytes in the spleen and bone marrow also was decreased （P<0.05）. In addition, the positive expression rate of CD68+CD86+ in the spleen tissue was decreased, and the positive expression rate of CD68+CD206+ was increased （P< 0.05）, the proportion of F4/80+CD86+ labeled cells in the peripheral blood was also decreased, the proportion of F4/80+CD206+ labeled cells was increased（ P<0.05）. Conclusion: DMF can increase the number of PLT in ITP mice, reduce the increase of megakaryocytes in the spleen and bone marrow, and regulate the levels of cytokines, thereby improving ITP. Its mechanism may be related to inhibiting the differentiation of macrophages into M1 type and promoting the differentiation to M2 type. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the immunological characteristics of different TCM patterns of primary immune thrombocytopenia( ITP) patients with failed first-line treatment and the response to eltrombopag. Methods From January, 2018 to September, 2021, the clinical data of 58 first-line failed ITP patients treated with eltrombopag were enrolled at First Affiliated Hospital of Zhejiang Chinese Medical University. Enrolled patients were divided into four groups based on TCM patterns, and their immune indicators, including lymphocyte subsets, immunoglobulin levels, and complement factors, with the efficacy of eltrombopag compared. Patients were classified into pattern of qi failing to control blood (22 cases), pattern of internal blockade of static blood(9 cases), pattern of bleeding due to blood heat (13 cases), and pattern of endogenous heat due to yin deficiency ( 14 cases) group based on TCM patterns. Results Comparative analysis of immune indexes of ITP patients with different TCM patterns showed that the percentage and absolute count of NK cells in the pattern of internal blockade of static blood group(16. 91%±7. 24%,(230. 33±188. 35) ×10 6 L -1 ) were significantly higher than those in the pattern of qi failing to control blood group(9. 76%±6. 33%,(109. 38± 76. 60)×10 6 L -1 ) and the pattern of bleeding due to blood heat group(5. 82%±3. 70%,(52. 50±40. 91) ×10 6 L -1 )(P<0. 05). However, there was no statistical difference in the levels of immunoglobulin and complement factors among all the groups. Comparison of the efficacy response of patients with different TCM patterns to eltrombopag showed that the effective rates in the pattern of qi failing to control blood, pattern of internal blockade of static blood, pattern of bleeding due to blood heat, and pattern of endogenous heat due to yin deficiency group were 68. 2%(15 / 22), 22. 2%(2 / 9), 61. 5%(8 / 13), and 78. 6%(11 / 14), respectively; the curative effect in the pattern of internal blockade of static blood group was different from that in the pattern of endogenous heat due to yin deficiency and pattern of qi failing to control blood group ( P < 0. 05). Conclusion The proportion of NK cells in patients’ peripheral blood may be involved in the difference of therapeutic response to eltrombopag in ITP patients with different TCM patterns. High NK cell counts are more common in ITP patients of the pattern of internal blockade of static blood group, which is related to the lower expected therapeutic response to eltrombopag. [ABSTRACT FROM AUTHOR]

Primary immune thrombocytopenia ( ITP ) is the most common hemorrhagic disease. In traditional Chinese medicine ( TCM), it belongs to the category of “ blood syndrome” or “ purpura. ” Ancient and modern physicians mostly treat it focusing on the spleen or spleen and kidney (TCM terms, not completely the same as the anatomical concepts), and there are also a few doctors who treat it based on the heart or liver (see above). In clinical practice, we found that treatment of ITP based on the lung often achieved better clinical efficacy. Based on ancient medical books and modern literature, we systematically put forward a new viewpoint of regulating blood through “lung qi aiding spleen to control blood” and “lung qi helping heart to transport blood” based on the theory of “ the lung is a blood-zang which can transform the blood” and “Jin-shui theoretical and mutual transformation between essence and blood. ” We also summarize three etiology and pathogenesis theories, lung qi affected by evil, lung qi deficiency, and yang deficiency with external cold manifestation. The four principles of replenishing and restoring lung qi, clearing heat and purging lung, nourishing yin and clearing lung, and warming lung for dispelling cold are proposed to treat ITP and we recommend classical prescriptions. This article broadens the scope of TCM treatment of ITP. [ABSTRACT FROM AUTHOR]

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Objective To explore the therapeutic effect of Yiqi Tongyang Granule in the treatment of immune thrombocytopenia mice and the underlying mechanism. Methods BALB / c mice were treated with anti-mouse platelet serum from guinea pig to establish an immune thrombocytopenia mouse model. Model mice were randomly devided into the model group, the prednisone group, the Yiqi Tongyang Granule group, and the Jinshuye group; 10 unmodeled mice as the control group. The mice were treated with Yiqi Tongyang Granule ( 17. 4 g / kg), prednisone ( 9. 1 mg / kg), and Jinshuye Styptic Mixture (3. 9 mL / kg) by gavage for 11 days, and the platelets ( PLT), white blood cells ( WBC), and hemoglobin (Hb) counts in the mice were measured. Bone marrow megakaryocyte counts were compared by bone marrow smears and bone marrow pathology, and the proportions of different types of megakaryocytes in bone marrow were analyzed. The organ coefficients and pathological changes of the spleen and thymus were observed in mice. Lymphocyte subsets were detected using a flow cytometer. Results Compared with the control group, the number of PLT in immune thrombocytopenia mice was reduced (P<0. 05), and after treatment with Yiqi Tongyang Granule, prednisone, and Jinshuye Styptic Mixture, the number of PLT was increased (P<0. 05). Compared with the control group, the number of bone marrow megakaryocytes was increased and the proportion of PLT-producing megakaryocytes was decreased in immune thrombocytopenia mice (P<0. 05). The number of megakaryocytes was decreased after treatment with Yiqi Tongyang Granule (P<0. 05), the ratio of primitive and naive megakaryocytes was decreased, and the proportion of PLT-producing megakaryocytes was increased in the immune thrombocytopenia mice ( P < 0. 05 ). The spleen was observed to be enlarged in the immune thrombocytopenia mice based on the spleen organ coefficient and pathology, and extramedullary hematopoiesis was found to be common in the spleens of immune thrombocytopenia mice. Thymus atrophy was very obvious in immune thrombocytopenia mice treated with prednisone based on the thymus organ coefficient and pathology. The percentages of Tc, Th, and Treg cells of immune thrombocytopenia mice were reduced, and these percentages were increased after treatment with Yiqi Tongyang granules (P< 0. 05 ). Conclusion Yiqi Tongyang Granule could regulate the immune state of immune thrombocytopenia mice by regulating the lymphocyte subpopulations and increase the PLT levels in peripheral blood by affecting the number of bone marrow PLT-producing megakaryocytes. The therapeutic effect of Yiqi Tongyang Granule was similar to that of prednisone and clearly superior to that of Jinshuye Styptic Mixture. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of Huaiqihuang granule in the treatment of children with idiopathic thrombocytopenic purpura (ITP) and its effect on platelet parameters, peripheral blood Treg/Th17 and CD4/CD8. Methods: From August2019 to May 2021, 60 children with immune thrombocytopenia treated in our hospital were selected as research subjects. Children were divided into Huaiqi Huang granule group according to the 1:1 simple distribution principle and the matched group. The matched group was given conventional drug-injection human immunoglobulin treatment, and the group was treated on the basis of the matched group.Both groups were treated for 3 months to observe the efficacy of treatment, platelet parameters, peripheral blood Treg/Th17 and CD4/CD8. Results: Post-treatment, the total effective rates of Huaiqihuang granule group were 96.7 %, which were higher than 80.0 % of matched group (P＜0.05).The onset time of Huaiqihuang granule group were shorter than that of the matched group, and the duration of the curative effect were longer than that of the matched group. there were difference compared between the two groups (P＜0.05).The platelet count and platelet parameters in the two groups Post-treatment were higher than those pretherapy, and the Huaiqihuang granule group were also higher than that in the matched group (P＜0.05).The Peripheral blood Treg/Th17 and CD4/CD8 in both groups post-treatment were higher than that pretherapy, and the Huaiqihuang granule group were higher than that in the matched group (P＜0.05). Conclusion: Huaiqihuang granules in the treatment of children with primary immune thrombocytopenia can effectively improve the therapeutic effect, shorten the onset time and prolong the duration of the effect, and can also effectively improve the platelet count and platelet parameters in children, increase Peripheral blood Treg/Th17 and CD4/CD8. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To study the expression level of plasma miR-106b-5p in primary immune thrombocytopenia (ITP) and its correlation with the levels of T helper 17 cell (Th17) and regulatory T cell (Treg) and the Th17/Treg ratio. Methods A total of 79 children with ITP (ITP group) and 40 healthy children (control group) were selected as subjects. According to the treatment response, the 79 children with ITP were divided into three groups: complete response (n=40), partial response (n=18), and non-response (n=21). Quantitative real-time PCR was used to measure the expression level of miR-106b-5p. Flow cytometry was used to measure the frequencies of Th17 and Treg, and the Th17/Treg ratio was calculated. The correlation of the expression level of plasma miR-106b-5p with the frequencies of Th17 and Treg and the Th17/Treg ratio was analyzed. Results Compared with the control group, the ITP group had significantly higher levels of miR-106b-5p, Th17, and Th17/Treg ratio (P<0.05) and a significantly lower level of Treg (P<0.05). After treatment the ITP group had significant reductions in the levels of miR-106b-5p, Th17, and Th17/Treg ratio (P<0.05) and a significant increase in the level of Treg (P<0.05). Compared with the partial response and non-response groups, the complete response group had significantly lower levels of miR-106b-5p, Th17, and Th17/Treg ratio (P<0.05) and a significantly higher level of Treg (P<0.05). The correlation analysis showed that in the children with ITP, the expression level of plasma miR-106b-5p was positively correlated with the Th17 level and the Th17/Treg ratio (r=0.730 and 0.816 respectively; P<0.001) and was negatively correlated with the Treg level (r=-0.774, P<0.001). Conclusions A higher expression level of miR-106b-5p and Th17/Treg imbalance may be observed in children with ITP. The measurement of miR-106b-5p, Th17, Treg, and Th17/Treg ratio during treatment may be useful to the evaluation of treatment outcome in children with ITP. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To explore the effect and mechanism of Eltrombopag combined with azathioprine in treatment of refractory idiopathic thrombocytopenic purpura(RITP). Methods: 61 patients with refractory idiopathic thrombocytopenic purpura admitted to our hospital from January 2016 to January 2020 were selected as the research subjects.According to the order of admission, they were divided into two groups according to the random number table method. 30 patients in the control group were treated with azathioprine, and 31 patients in the study group were treated with eztropa combined with azathioprine.The treatment effects, peripheral blood Th lymphocyte factor levels, B1 lymphocyte percentage, and oxidative stress response indexes were compared between the two groups. Results: The total effective rate of treatment in the study group was 90.32 %, which was significantly higher than that in the control group(73.33 %, P <0.05). Before treatment, there was no significant difference in the levels of interleukin(IL)-2, interferon gamma(IFN-γ), IL-4, and IL-5 between the two groups of patients(P>0.05). After treatment, the levels of IL-2 and IFN-γ in the two groups decreased, and the levels of IL-4 and IL-5 increased, and the study group was better(P<0.05). Before treatment, there was no significant difference in CD19+lymphocyte percentage and CD5+CD19+lymphocyte percentage between the two groups(P>0.05). After treatment, the percentage of CD19+lymphocytes and CD5+CD19+lymphocytes in two groups were significantly lower, and the study group was significantly lower than the control group(P<0.05). Before treatment, there was no significant difference in the levels of total antioxidant capacity(TAC),superoxide dismutase(SOD), melatonin(MT) and glutathione(GSH) between the two groups(P>0.05). After treatment, the TAC, SOD,MT, and GSH levels of the two groups were significantly higher, and the study group was significantly higher than the control group(P<0.05). Conclusion: Eltrombopag combined with azathioprine has a significant effect on RITP, and its mechanism may be related to improving the immune function and oxidative stress state of the patient. This method is worthy of recommendation to be widely used in clinic. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect and mechanism of Eltrombopag combined with azathioprine in treatment of refractory idiopathic thrombocytopenic purpura(RITP). Methods: 61 patients with refractory idiopathic thrombocytopenic purpura admitted to our hospital from January 2016 to January 2020 were selected as the research subjects.According to the order of admission, they were divided into two groups according to the random number table method. 30 patients in the control group were treated with azathioprine, and 31 patients in the study group were treated with eztropa combined with azathioprine.The treatment effects, peripheral blood Th lymphocyte factor levels, B1 lymphocyte percentage, and oxidative stress response indexes were compared between the two groups. Results: The total effective rate of treatment in the study group was 90.32 %, which was significantly higher than that in the control group(73.33 %, P <0.05). Before treatment, there was no significant difference in the levels of interleukin(IL)-2, interferon gamma(IFN-γ), IL-4, and IL-5 between the two groups of patients(P>0.05). After treatment, the levels of IL-2 and IFN-γ in the two groups decreased, and the levels of IL-4 and IL-5 increased, and the study group was better(P<0.05). Before treatment, there was no significant difference in CD19+lymphocyte percentage and CD5+CD19+lymphocyte percentage between the two groups(P>0.05). After treatment, the percentage of CD19+lymphocytes and CD5+CD19+lymphocytes in two groups were significantly lower, and the study group was significantly lower than the control group(P<0.05). Before treatment, there was no significant difference in the levels of total antioxidant capacity(TAC),superoxide dismutase(SOD), melatonin(MT) and glutathione(GSH) between the two groups(P>0.05). After treatment, the TAC, SOD,MT, and GSH levels of the two groups were significantly higher, and the study group was significantly higher than the control group(P<0.05). Conclusion: Eltrombopag combined with azathioprine has a significant effect on RITP, and its mechanism may be related to improving the immune function and oxidative stress state of the patient. This method is worthy of recommendation to be widely used in clinic. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To explore the therapeutic effect of plasma exchange and platelet transfusion on idiopathic thrombocytopenic purpura. Methods: 60 patients with idiopathic thrombocytopenic purpura who were treated in our hospital from February 2016 to January 2019 were selected as the research object, and they were divided into platelet transfusion group (20 cases) and plasma according to the difference in treatment options In the Plasma exchange (PE) group (40 cases), the treatment efficiency, changes in blood cell counts before and after treatment, and the occurrence of various adverse reactions during treatment were compared between the two groups. Results: In the platelet transfusion group, there were 10 cases of effective treatment, 6 effective cases, and the total effective rate was 80.00 %. In the PE group, there were 27 cases of effective treatment, 12 effective cases, and the total effective rate was 97.50 %. The difference is obvious(P<0.05). Compared with before treatment, the PLT, RBC count and Hb levels of PE patients increased significantly, the WBC count decreased significantly (P<0.05), and the PLT, RBC count and Hb levels of platelet transfusion group also increased significantly High, the WBC count level decreased (P<0.05), but the comparison between the groups showed that the above indexes of the PE group after treatment were better than the platelet transfusion group (P<0.05). The total number of adverse reactions in the platelet transfusion group was 4 and the total incidence of adverse reactions was 20.00%. The total number of adverse reactions in the PE group was 3 and the total incidence of adverse reactions was 7.50%. Lower than platelet transfusion group (P<0.05). Conclusion: Platelet transfusion and plasma exchange have a good therapeutic effect on idiopathic thrombocytopenic purpura, which can significantly improve the patient's abnormal blood cell count, but plasma exchange treatment is more safe. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influencing factors for the clinical efficacy of platelet transfusion in the treatment of patients with hemopathy. Methods: 156 cases of patients with hemopathy who were treated by platelet transfusion in our hospital from January 2013 to December 2015 were selected. All the patients were given 12 U platelet 2.5 x 1011), the corrected count increment (CCI) after transfusion and the effect of disease category, splenomegalia, fever, age, gender with on the clinical efficacy of platelet transfusion were analyzed. Results: The total effective rate of platelet transfusion was 71.0%, which was 65.9%, 65.7%, 77.7% and 71.9% in patients with aplastic anemia(AA), idiopathic thrombocytopenic purpura(ITP), acute leukemia(AL), myelodysplastic syndrome (MDS) respecctively, no significant difference was found between different disease categories (P>0.05). The effective rate was 69.9% in febrile patients, which was obviously lower than those non-febrile patients (77.6%, P<0.05); the effective rate was 74.9%, which was overtly lower than those with splenomegalia(52.86%, P<0.05); no significant difference was found in the effective rate between male and female, <60 years old and years old (76.5% vs. 75.8%, 72.0% vs. 113%){P>0.05). With the incease of transfusion times, the incidence of platelet transfusion refractoriness was gradually elevated (P<0.05). Conclusions: Splenomegalia and fever were adverse factors for the clinical efficacy of platelet transfusion in the treatment of patients with hemopathy. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To explore the clinical effect of different dose gamma globulin combined with dexamethasone in the treatment of idiopathic thrombocytopenic purpura (UP) in children. Methods: 78 children with ITP accepted in our hospital from July 2010 to July 2015 were randomly divided into observation group with 38 cases and control group with 40 cases. 200 mg/ (kg-d) gamma globulin combined with dexamethasone was given to observation group, and 400 mg/ (kg -d) gamma globulin combined with dexamethasone was given to control group. Then the clinical efficacy, platelet counts before and after treatment, the time of platelet risen time, platelet and recovery, and the time of stopping bleeding, hospital stays, adverse reactions and medical costs of two groups were observed and compared. Results: Platelet counts before treatment of two groups had no statistically significance (P>0.05), and were raisen duiing treatment (P<0.05). But the difference between two groups after treatment had no statistically significance (P>0.05). Platelet risen time, platelet recovery time, stop bleedmg time and hospital stays of two groups had no difference (P>0.05). Total efficacy of observation group was 94.74%, control group was 95.00 %, there were no statistically difference (P>0.05). The adverse reaction rate of observation group was 8.17 %, of control group was 12.50 %, and there were no statistically difference between two groups (P>0.05). The medical costs of observation group were lower than that of control group, and the difference had statistically significance (P<0.05). Conclusions: Different dose gamma globulin combined with dexamethasone has similar efficacy and safety in the treatment of idiopathic, but using low dose gamma globulin can decrease medical costs, which is worth clinical application. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the mode and method of dynamic pharmaceutical care carried out by clinical pharmacists in clinical practice. METHODS: Retrospective analysis of dynamic pharmacological care for a patient with primary thrombocytopenic purpura and invasive pulmonary aspergillosis was performed by the clinical pharmacists. In view of anti-infective, immunosuppressive, cough and phlegm and other symptomatic treatment, combined with clinical changes, the clinical pharmacists dynamically analyzed the drug treatment, provided constructive treatment recommendations and assisted the physicians to develop the optimization treatment regimen. RESULTS: Most of the recommendations of clinical pharmacists were adopted, and the symptoms of fever, cough, chest tightness and shortness of breath were significantly improved. CONCLUSIONS: The dynamic pharmaceutical care of clinical pharmacists for the whole process of clinical treatment improves the effect of drug treatment and the quality of life of the patients and reduces the occurrence of sever adverse drug reactions. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety of renal transplantation in patients with idiopathic thrombocytopenic purpura (ITP). Methods Clinical data of two ITP patients undergoing renal transplantation were retrospectively analyzed and pertinent literatures were reviewed. Results Prior to renal transplantation, the platelet count of these two patients was 41 ×109 /L and 34 ×109 /L, respectively. The coagulation function was normal and no active bleeding was observed. They underwent renal transplantation successfully without obvious bleeding intra-or post-operatively. The platelet count of one patient who received hydrocortisone impulse therapy for three days and maintenance treatment with immunosuppressant based on ciclosporin recovered to normal range and kept stable at 7 days after renal transplantation. Though receiving platelet-promoting drugs and platelet infusion, the platelet count of the other patient treated with methylprednisolone impulse therapy for 3 days and maintenance therapy with immunosuppressant based on tacrolimus did not recover to normal range but fluctuated between 10 ×109 /L and 30 ×109 /L after renal transplantation. Renal function was well maintained in both recipients. Conclusions The risk of renal transplantation related bleeding in ITP patients is correlated with whether the preoperative active bleeding or not. Renal transplantation is relatively safe for uremia patients without active bleeding pre-operation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of Treg-cells on the primary immune thrombocytopenia by detecting the level changes of peripheral blood regulatory T cells of the patients with ITP before and after the treatments. Methods: 276 patients with ITP who were treated in the department of hematology in our hospital from June 2010 to July 2013 were enrolled in the study. According to the different therapeutic methods, the selected patients were divided into three groups. DXM group (90 cases): dexamethasone 40 mg/d taken by mouth in 4 days; Prednisolone group(98 cases): prednisolone 1.5 mg-kg-1.d-1 taken by mouth; DXM+low dose Rituximab group (88 cases): dexamethasone 40 mg/d taken by mouth form the 1st day to the 4th, and then the Rituximab 100 mg was given by intravenous drip on the 7th, 14th, 21th and 28th. Another 60 healthy people who were inspected in our hospital were chosen to be the control group. The peripheral vein blood of patients in each group at the 14th and 28th day before and after the treatments was taken separately in order to detect the levels of CD4+, CD25+, CD127- in Tr cells were examined by flow cytometry. Results: On the 28th day, the total effective rate of Prednisolone group, Dexamethasone (DXM) group and DXM+low dose Rituximab group was 69.4%, 66.7% and 79.5%, respectively, with no significant difference. In the 12-months' follow-up, the continuous effective rate of DXM+low dose Rituximab group (66.7%) was higher than Prednisolone group(37.8%) and Dexamethasone (DXM) group (22.7%) with a significant difference(P<0.05). There was no significant difference between Prednisolone group and Dexamethasone (DXM) group. The expression levels on peripheral blood CD4+, CD25+ and CD127-T cells of the all ITP patients were lower than those of the patients in the health control group before the treatments[(1.66± 0.69)%VS(4.01± 0.38)%, P<0.05]. On the 14th day, the levels of CD4+, CD25+ and CD127-Tr cells of patients in Prednisolone group and Dexamethasone (DXM) group were higher than before with an average rate of [(3.46± 0.76)% VS (1.68± 0.72)%, (3.22± 0.77)% VS (1.69± 0.74)%, respectively, P<0.05]; On the 14th and 28th day of the treatments, the levels of CD4+, CD25+ and CD127- of the DXM+low dose Rituximab group were higher than before with significant differences (P<0.05). On the 28th day, the levels of CD4+, CD25+ and CD127-Tr cells of patients in Prednisolone group and Dexamethasone (DXM) group were (2.68± 0.63)% and (2.58± 0.66)% which showed no significant difference when comparing with before. Conclusion: The regimen of DXM+low dose Rituximab is superior to single medication of prednisolone and dexamethasone in promoting the number of T cells and long-term treatments. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of clinical pathway-based teaching methods in clinical teaching of hematology. Methods Interns， which studied in department of hematology， were classified non-randomized into two groups. The interns in experimental group received idiopathic thrombocytopenic purpura （ITP） clinical pathway-based teaching. And the interns in the control group received the seventh edition textbook of medicine-based traditional teaching. All interns were oral tested when they finished two weeks period clinical studied of hematology. Meanwhile，a questionnaire designed for clinical pathway-based teaching was included in this test only for the experimental group. Results There were 32 interns recruited in the group of clinical pathway-based teaching and 38 interns in the control group of traditional teaching. There were statistically significant differences between the two groups in the fields of the key points about history of diseases（ = 0.0017）， assessment of diagnostic criteria and differential diagnosis（ = 0.0074）， selection of laboratory examination items （ < 0.0001） for ITP. The group of clinical pathway-based teaching achieved higher scores than the control group. However，there was no statistically significant difference between the two groups in the field of selection of first-line treatment measure of ITP（ = 0.1155） . Moreover， the control group achieved higher scores than the group of clinical pathway-based teaching in the field of how to treat ITP patients with first-line treatment failure（ = 0.0003） . In addition，there were 93.8%interns in the experimental group accepted the new clinical pathway-based teaching tool in the survey. The open-ended question survey showed the clinical pathway teaching method was more simple， intuitive and standardizing than the traditional one. Conclusion The ITP clinical pathway，as an interns teaching tool of hematology，is helpful for understanding more clearly the diagnosis and treatment of ITP. However，an in-depth explanation is necessary combination with textbook of medicine study in the clinical teaching of ITP. [ABSTRACT FROM AUTHOR]

Zhigancao decoction recorded in Treatise on Febrile Disease by Zhang Zhongjing in the Han dynasty have been widely used in treating palpitation and irregular pulse by traditional Chinese medicine physicians for thousands of years. It is all known that Zhigancao Decoction is used to treat consumptive disease. However,why it has been used to treat exogenous febrile disease? According to studies,Fumai Decoctions in Treatise on Differentiation and Treatment of Epidemic Febrile Disease,that was modified based on Zhigancao Decoction,have their names without reality. Serious defects,including unclear diagnosis,curative effect,and prognosis,have been found in ancient and modern medical records about Zhigancao Decoction. The indications of Zhigancao Decoction include atrial premature beats,ventricular premature beats,and viral myocarditis; tachyarrhythmia( supraventricular tachycardia,atrial fibrillation)with long interval or conduction block,during or after severe infection or high fever; chronic consumptive disease due to tumor after radiotherapy and chemotherapy,malignant fluid state of tumor,hematopathy,terminal stage of heart failure after major operation,and acute hemorrhage after control of severe infection and other major diseases; cough,phlegm and asthma due to chronic obstructive pulmonary disease,pulmonary interstitial fibrosis,lung cancer,after lung cancer surgery; increased heart rate and decreased blood pressure due to insufficient capacity after acute blood loss; the symptoms included palpitation,chest tightness,sweating,lassitude,lacking in strength,shortness of breath,syncope,sudden death,cough,expectoration,excessive phlegm,clear and dilute sputum,emaciation,dry and haggard skin,constipation,haemorrhagic,uterine bleeding,enjoy sweet taste,red tongue without moss,knotted pulse,intermittent pulse,thready rapid pulse,and weak pulse. Besides,Zhigancao Decoction has effect on cardioversion and maintenance of sinus rhythm without thrombosis in persistent atrial fibrillation and permanent atrial fibrillation. Zhigancao Decoction could stop bleeding soon for acute upper gastrointestinal bleeding,and achieve positivity of occult blood test; Zhigancao Decoction could promote thrombocytopenia for idiopathic thrombocytopenic purpura,with the number of platelets 1×109/L. Zhigancao Decoction could promote the rise of granulocytic,erythroid and megakaryocytic hematopoietic lines in unexplained severe anemia,thrombocytopenia,and leukocyte reduction. Zhigancao Decoction could treat cough,asthma,and chest tightness in lung cancer and after lung cancer surgery; chronic consumptive disease due to lung cancer after lung cancer surgery,hematopathy and acute blood loss,which all belonged to the scope of consumptive disease. Zhigancao Decoction could ascend platelets,which was considered as " oriental interleukins" for the ancients. Zhigancao Decoction possesses dual-directional regulation on anticoagulant and hemostasis,which was considered as " oriental low molecular heparin" and " oriental proton pump inhibitors". Large dose of Rehmannia glutinosa is the key of the efficacy of Zhigancao Decoction. This study is expected to enrich the guidelines for modern medical diagnosis and treatment. However,the clinical evidence,relevant genes and targeting network need to be deepened in future studies. In conclusion,it may be a shortcut to restore and explain Zhigancao Decoction formula syndromes based on modern pathophysiology and severe cases of critical care.