Objective:To investigate the clinical characteristics of severe purulent meningitis in neonates.Methods:A retrospective study was conducted.One hundred and sixty-nine newborns with purulent meningitis diagnosed at the neonatal center of our hospital from January 2014 to December 2017 were selected.According to the severity of the disease, the cases were divided into severe group and mild group.The clinical data of all children were collected and analyzed, and the characteristics of severe purulent meningitis were summarized.Results:Among 169 cases of neonatal purulent meningitis, 43 cases(25.4%)were in severe group, and 126 cases(74.6%)were in mild group.Twenty-one cases were cured in severe group, 10 cases had complications, 9 cases abandoned and 3 cases died.Ninty-eight cases were cured in the mild group, 17 cases had complications and 11 cases were discharged automatically and 2 cases died.There were significant differences in respiratory failure requiring mechanical ventilation, convulsion, consciousness disorder, blood C-reactive protein, positive cerebrospinal fluid culture, severe abnormality of amplitude integrated electroencephalogram, cerebrospinal fluid/serum glucose ratio, the incidence rate of complications and mortality between two groups( P<0.05). Conclusion:Severe purulent meningitis not only has the manifestation of mild meningitis, but also often has the clinical characteristics of brain parenchymal damage and/or brain failure with more complications and higher mortality.

Objective To explore the value of amplitude-integrated electroencephalography(aEEG) in diagnosis and prognosis in term newborns with brain injury.Methods One hundred and thirty consecutive patients with brain injury admitted in NICU were prospectively enrolled in the study from Nov 2013to Apr 2015.The monitoring of aEEG was done at 1d,4d,7d,respectively.Clinical data were collected and com-pared with the result of aEEG.Results All the cases of newborns with abnormal aEEG background:discon-tinuous voltage(109cases),continuous low voltage(12cases),flat(4cases).The epileptic activity were re-corded in 33cases,and 15cases showed burst-suppression;sleep wake cycle:mature(32cases),immature (54cases),no sleep wake cycle(39cases).The judgment of abnormal level:70cases had mildly abnormal aEEG,severe abnormalities 60cases,and no significant difference in different types of diseases(x2=6.176, P=0.19).Recent prognosis:the death of mild and severe abnormalities were 1case,12cases,respectively, there were significant differences(x2=12.76,P﹤0.001).Developmental quotient(DQ)of these newborns were followed up for more than 6months,and there were significant differences in mild,severe abnormal aEEG in them with DQ≥85and DQ﹤85(x2=33.195,P﹤0.001).The sensitivity of aEEG in severe abnor-mal aEEG was 68.75%,the specificity was 78.68%,and the positive and negative predictive values of aEEG were 77.19%and 70.58%,respectively.The results of aEEG classification and sleep wake cycle were corre-lated with the prognosis of the patients(r=0.505,0.507,respectively,P﹤0.001).Conclusion aEEG can be used to monitor brain function,and it is helpful to evaluation of early diagnosis and prognosis.

ObjectiveTo explore the clinic symptom and the characteristics of video,tightly close,intracranial electroencephalogram (EEG) of patients with central region diastematia epilepsy. Methods Retrospective analysis of 9 patients with central region diastematia epilepsy admitted from June,2007 to August,2009.The characteristics of all patients' seizure symptom and EEG manifestation were analyzed using patients' medical history,video and EEG records.ResultsPatients with central region diastematia epilepsy had relatively long sezure history.The duration of seizure was commonly short,with frequent episode and no obvious intelligence impairment.The seizure was often accompanied with the hyperkinesia in the lower limbs.Scalp EEG showed discharges with low amplitude waves in the mean line area.The superhigh amplitude and regular rhythm slow sharp wave could be found in the diastematia cortex EEG.All patients had an Engel Class Ⅰ outcome after surgery.ConclusionThe seizure symptoms are characteristic in the patients with central region diastematia epilepsy,and some special manifestations can be found in different phase,wave amplitude,rhythm,lead array.

Objective To study the relationship of Wnt receptor signaling pathway and severe retinopathy of prematurity (ROP).Method From January 2011 to June 2015,preterm infants with severe ROP admitted to the NICU of our hospital were enrolled prospectively.Preterm infants with similar gestational age,gender,and age (in days) admitted to our hospital during the same period were selected as the control group.FZD4,LRP5,and ND gene mutations in Wnt receptor signaling pathway were examined.Result A total of 61 Chinese preterm infants were screened for these three candidate genes of Wnt receptor signaling pathway,32 in ROP group and 29 in control group.ND and FZD4 gene mutations were not found among all cases.Eight types of LRP5 mutations were found in 26 cases of ROP group,including 7 cases of Exon18 missense mutation [c.3989C ＞ T;p.Ala1330Val (rs3736228)],5 cases of Exon8 synonymous mutation (c.1647T ＞ C;p.Phe549Phe),5 cases of Exon6 intronic mutation [c.1412 + 8G ＞ A (rs4988319)],3 cases of Exon2 missense mutation [c.266A ＞ G;p.Gln89Arg (rs41494349)],2 cases of Exon21 intronic mutation [c.4349-17C ＞ T (rs372086596)],2 cases of Exon19 synonymous mutation (c.4089C ＞ T;p.Asp 1363 Asp),one case of Exon9 synonymous mutation (c.1 932G ＞ A;p.Glu644Glu),and one case of Exon16 missense mutation (c.3580C ＞T;p.Arg1194Cys).Three types of LRP5 mutations were found in 6 cases of the control group,including 4 cases of Exon8 synonymous mutation,one case of Exon19 synonymous mutation,and one case of Exon9 synonymous mutation.The positive rates of Exonl8 missense mutation and Exon6 intronic mutation in severe ROP group were significantly higher than the control group (P ＜ 0.05).Conclusion LRP5 gene mutations in Wnt receptor signaling pathway may be associated with the occurrence of severe ROP.

Background::Acute pulmonary embolism (APE) is a fatal cardiovascular disease, yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs. A simple, objective technique will help clinicians make a quick and precise diagnosis. In population studies, machine learning (ML) plays a critical role in characterizing cardiovascular risks, predicting outcomes, and identifying biomarkers. This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods::This is a single-center retrospective study. Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets. A total of 8 ML models, including random forest (RF), Na?ve Bayes, decision tree, K-nearest neighbors, logistic regression, multi-layer perceptron, support vector machine, and gradient boosting decision tree were developed based on the training set to diagnose APE. Thereafter, the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies, including the Wells score, revised Geneva score, and Years algorithm. Eventually, the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic (ROC) analysis.Results::The ML models were constructed using eight clinical features, including D-dimer, cardiac troponin T (cTNT), arterial oxygen saturation, heart rate, chest pain, lower limb pain, hemoptysis, and chronic heart failure. Among eight ML models, the RF model achieved the best performance with the highest area under the curve (AUC) (AUC = 0.774). Compared to the current clinical assessment strategies, the RF model outperformed the Wells score ( P = 0.030) and was not inferior to any other clinical probability assessment strategy. The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726. Conclusions::Based on RF algorithm, a novel prediction model was finally constructed for APE diagnosis. When compared to the current clinical assessment strategies, the RF model achieved better diagnostic efficacy and accuracy. Therefore, the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

Objective To investigate the clinical characteristics of neonatal inflammatory bowel disease (IBD). Methods The clinical data of two neonates diagnosed with IBD. Clinical manifestation, laboratory examination, imaging, endoscopy and histopathological findings, treatment plan and prognosis were included. Results The clinical manifestations were fever, diarrhea, oral ulcer in two cases of neonatal IBD in this study. Laboratory findings showed inflammatory indicators (such as white blood cells, C-reactive protein) increased mainly accompanied by decreased hemoglobin, platelet, plasma albumin and other indicators. Endoscopic and pathological manifestations were significantly different in ulcerative colitis (UC) and Crohn disease (CD) children. The lesions range of UC patients were mainly sigmoid colon, and CD patients ileocecal. Conclusions For neonates with highly suspected IBD, positive endoscopy and gene detection are recommended. Early diagnosis and standard treatment are important. For children with refractory IBD with IL-10 and IL-10 receptor gene mutations, hematopoietic stem cell transplantation is feasible and could improve its prognosis.

We reported a case of neonatal Langerhans cell histiocytosis (LCH) with his clinical manifestations, examinations, diagnosis and treatment. This infant was hospitalized due to the rash and poor response. He was diagnosed as LCH after admission by imaging, skin biopsy and immunohistochemistry. The infant died because his parents refused all possible treatments. At the moment, no effective treatment is available for LCH patients, while the main managements are infection control and necessary supportive care. Pulmonary infections often contribute to the death of LCH patient and can aggravate the situation by stimulating histiocytic hyperplasia.

OBJECTIVE: To explore the clinical characteristics, genetic basis and clinical treatment of seven neonates with congenital nephrogenic diabetes insipidus (NDI). METHODS: Clinical data of the patients were collected. High-throughput sequencing was carried out to detect potential variants. Sanger sequencing was used to verify the results. RESULTS: The patients were all males, with the age of onset being 10 to 21 days. All patients were admitted to the hospital for intermittent fever as the first symptom during the neonatal period. Additional symptoms had included polydipsia and polyuria. After the treatment, 5 patients had recovered, the remainders still had NDI symptoms and developmental retardation. Five children were found to harbor pathogenic variants of the AVPR2/AQP2 gene, which included one in-frame mutation of c.645_646insGCACCTACCCTGGGTATCGCC, two missense mutations of c.541C>T and c.419C>A, and two hemizygous deletions of the AVPR2/AQP2 gene. Among these, two were unreported previously. Cases 6 and 7 were a pair of twins. Both had carried homozygous missense variants of c.538G>A of the AVPR2/AQP2 gene, which was known to be pathogenic. CONCLUSION AVPR2/AQP2 is the main pathogenic gene for congenital NDI, for which two novel pathogenic variants have been discovered in this study. Above results have provided a basis for clinical diagnosis and genetic counseling for the affected pedigrees.
Aquaporin 2/genetics* ; Child ; Diabetes Insipidus, Nephrogenic/genetics* ; Diabetes Mellitus ; Humans ; Infant, Newborn ; Male ; Molecular Biology ; Mutation ; Pedigree ; Receptors, Vasopressin/genetics*

Objective:To investigate the predictive value of total cholesterol / high density lipoprotein cholesterol ratio (TC/HDL) for ischemic stroke in patients with coronary heart disease (CHD) .Methods:A total of 1 983 inpatients with CHD in the Affiliated Hospital of Jining Medical University from January 1, 2017 to December 31, 2017 were selected as subjects by cluster sampling method. The clinical data were collected and followed up prospectively for 2 years.Results:During the 2-year follow-up period, 36 cases of ischemic stroke occurred in patients with CHD, and the incidence rate was 1.82% (36/1 983) . There was a curvilinear relationship between TC/HDL and ischemic stroke in male patients with CHD, and the tipping point was 3.84.When TC / HDL was less than 3.84, TC / HDL was negatively correlated with the incidence of ischemic stroke. The incidence of ischemic stroke decreased by 72% for each additional unit of TC/HDL ( P=0.049) . When TC/HDL was over 3.84, there was no correlation between TC / HDL and the incidence of ischemic stroke ( P=0.267) . There was a curvilinear relationship between TC/HDL and ischemic stroke in female patients with CHD, and the tipping point was 2.81. When TC / HDL was less than 2.81, TC / HDL was negatively correlated with the incidence of ischemic stroke. The incidence of ischemic stroke decreased by 99% for each additional unit of TC/HDL ( P=0.019) . When TC/HDL was over 2.81, there was no correlation between TC / HDL and the incidence of ischemic stroke ( P=0.110) . Conclusions:TC/HDL has different thresholds in predicting ischemic stroke in CHD patients with different genders, which has a certain clinical significance in predicting the prognosis of patients with coronary heart disease.

Objective To evaluate the clinical outcomes and prognosis of older human immunodeficiency virus (HIV )-infected patients under antiretroviral therapy (ART ) in China .Methods This study was carried out in a retrospective cohort of HIV-infected patients initiated ART between January 2004 and December 2012 at The First Affiliated Hospital ,China Medical University .The patients were enrolled and divided into two groups ,including <50 years group (young and middle-aged group) and≥50 years group (older group) .Immunological and virological responses and mortality were analyzed . Data were analyzed by t test ,chi-square test ,two-way analysis of variance and log-rank test .Results Totally 291 subjects were included ,among whom 97 subjects were older patients and 194 subjects were young and middle-aged patients .Male was predominate in both groups ,which accounted for 91 .8％ and 87 .6％ ,respectively .The CD4+ T lymphocyte count in the older group before treatment was (151 .9 ±96 .2) cells /μL ,which was significantly lower than that in the young and middle-aged group (183 .4 ± 93 . 5) cells/μL (t= 2 .657 , P=0 .009) .At month 12 of treatment ,the CD4+ T lymphocyte count in the older group was significantly lower than that in the young and middle-aged groups (t= 2 .120 , P=0 .035) ,while there was no statistically significant difference between the two groups at month 24 (t=1 .025 ,P=0 .299) .The percentage of CD4+ T lymphocyte count increasing to 500 cells/μL in the older and youth groups during follow-up were 11 .3％ and 16 .0％ ,respectively (χ2=1 .127 ,P =0 .376) .Log-rank analysis showed that the mean times of virus inhibition in older group and young and middle-aged group were 7 .9 (95％ CI:6 .8-8 .5) and 7 .6 (95％ CI:6 .5 -9 .3) ,respectively ,with no statistically significant difference (χ2 =0 .002 , P=0 .961) .Virological failure was reported in 4 patients (4 .1％ ) in older group and 11 patients (5 .7％ ) in young and middle-aged group . Chi-square test showed no statistically significant difference between the two groups (χ2 = 0 .15 , P= 0 .78) .During follow-up , 19 .6％ (19/97) in older group and 3 .6％ (7/194) in young and middle-aged group died .The former was significantly higher than the latter (χ2 = 21 .113 , P< 0 .01 ) .Conclusions Older patients show a poor immunologic response ,similar viral suppression and higher risk of mortality compared with young and middle-aged patients . Future research should be aimed at the feasible and specific strategy for early diagnosis and timely treatment for older patients to improve treatment efficacy and reduce mortality .