Blood Group Incompatibility ; complications ; Erythroblastosis, Fetal ; etiology ; Humans ; Infant, Newborn ; MNSs Blood-Group System ; immunology ; Male

Objective To explore the effects of lactoferrin on T cells ( the levels of CD4 + T and CD8 +T lymphocytes) and the development of intestinal mucous membrane (villus heights, crypt depths, villus circumferences, and villus areas) in neonatal SD rats. Methods Totally 96 neonatal (one week old) SD rats were equally and randomly divided into twelve groups, in which animals were fed with lactoferrin at a dose of 1.0 g/( kg · d) (dose Ⅰ group), 3.0 g/(kg · d) (dose Ⅱ group), or 5.0 g/(kg · d) (dose Ⅲ group) for 2, 3, or4 weeks,with corresponding blank control groups. Rats in the dosage groups were killed at the set time points and the levels of venous blood CD4 + and CD8 + T lymphocytes were detected using immunofluorescence method. Jejunum ( 1 cm)and ileum (1 cm) specimens were obtained for pathological sectioning, and the villus height, crypt depth, villus circumferences, and villus areas were measured through image analysis system. Results The CD4 + T lymphocyte levels at two weeks were significantly different among dose I group, dose Ⅱ group, and control groups ( all P ＜0. 05).The CD8 + T lymphocyte levels at two weeks were significantly different among dose Ⅱ group, dose Ⅲ group,and control groups ( all P ＜ 0. 05 ). The villus heights, crypt depths, villus circumferences, and villus areas of jejunum at two weeks between feeding groups and control groups were not significantly different ( all P ＞ 0. 05 ), while the condition in ileum was on the contrary. The CD4 + T lymphocyte levels at three weeks were significantly different between feeding groups and control groups ( P ＜ 0. 05 ). The CD8 + T lymphocyte levels at three weeks between dose Ⅲ group and control groups were significantly different ( P ＜ 0. 05 ). The villus heights, crypt depths, villus circumferences, and villus areas of jejunum and ileum at three weeks were significantly different between feeding groups and control groups ( all P ＜ 0. 05 ). The CD4 + T lymphocyte levels at four weeks between feeding groups and control groups were significantly different (P ＜0. 05). The CD8 + T lymphocyte levels at four weeks were significantly different among dose Ⅱ group, dose Ⅲ group, and control groups ( all P ＜ 0. 05 ). Except villus areas of ileum, the villus heights, crypt depths, villus circumferences of jejunum and ileum, and villus areas of jejunum at four weeks were significantly different between feeding groups and control groups ( all P ＜ 0.05 ). Conclusions Lactoferrin can promote the levels of CD4 + and CD8 + T lymphocytes in venous blood and facilitate the development of the mucous membranes of jejunum and ileum. However, such effects are affected by the dose and timing of lactoferrin feeding.

Objective To investigate the flexibility of both the covered stents specially designed for use in intracranial vasculature and the delivering system in passing through the bone tube and the physiological curves of the cranial internal carotid artery(CICA)to reach the targeted area,the performance (adherence)of the covered stents in occluding vascular wall diseases and the impact on the vascular branches of the covered segment.Methods The covered stents specially designed for use in intracranial vaseulature were used to treat 13 patients with CICA diseases using endovascular techniques.There were 4 huge pseudoaneurysms,4 giant aneurysms,3 small wide-necked aneurysms,1 giant pseudoaneurysm with concurrent internal carotid cavernous fistula(CCF),and 1 CCF.Prior to the detachment of the covered stents,balloon occlusion test(BOT)of the internal carotid artery on the diseased side and whole-brain digital subtraction angiography(DSA)were performed in all the patients.Three to 16 months following procedure,DSA and clinical follow-ups were performed.Results Thirteen patients all tolerated the BOT well with the DSA demonstrating well-opened anterior and posterior communicating arteries.The covered stents and the delivering systems all successfully passed CICA to reach the targeted diseased area,with the diseased segments of the internal carotid artery including C3—C4 in 4 cases,C4—C5 in 4 and C6—C7 in 5.Immediately following the detachment of the covered stents,DSA demonstrated that 7 aneurysms were completely occluded,4 aneurysms had slight endoleak,and 1 CCF had markedly-decreased blood flow through the fistula.In the patient with concurrent pseudoaneurysm and CCF,the pseudoaneurysm disappeared and the blood flow through the fistula was markedly-reduced immediately following the stenting procedure.Apart from one patient with aneurysmal subarachnoid hemorrhage who died due to extensive vascular spasm on the 9th day following the stenting procedure,all the other 12 patients had unobstructed stented vessels on the follow-up DSA images,with 2 demonstrating slight stenosis.In the 6 patients with post-procedure endoleak,DSA showed that the endoleak in 4 patients had disappeared,one endoleak disappeared following the second stenting,and one CCF remained low-flow fistula.There was no sequela related to the occlusion of branches in the covered arterial segment.Conclusion The covered stents specially designed for use in the intracranial vasculature and the delivering system are both flexible enough to pass the tortuous CICA to reach the intracranial diseased artery,and are effective in managing CICA diseases.Further follow-up is still needed to determine the long-term effect of the covered stents,and the adherence of the covered stents needs further investigation.

Objective:To investigate the expression of N-myc downstream regulated gene 2(NDRG2) in hippocampus of epileptic mice and its effect on glutamate and glucose uptake in astrocytes of mice.Methods:The epileptic mouse model was induced by lithium chloride and pilocarpine nitrate. The mice were sacrificed at 1 d, 7 d, 15 d and 6 weeks after model establishment and the brain tissues of hippocampus were taken. Western blot was used to detect the expression of NDRG2 protein in hippocampus.The primary astrocytes of wild-type, NDRG2 + /+ and NDRG2 -/- mice were cultured and the NDRG2 phenotype of astrocytes was identified after primary culture. Glutamate content in the supernatant of astrocyte culture was determined by glutamate assay kit and ultraviolet spectrophotometer. Flow cytometry was used to detect the positive rate of 2-NBDG fluorescently labeled astrocytes. Results:(1) Compared with the control group (0.25±0.07), the expression of NDRG2 in the hippocampus of mice increased significantly in the acute phase of epilepsy (1 d(0.45±0.06, t=-3.84, P<0.05), 7 d(0.54±0.09, t=-4.30, P<0.05), 15 d(1.04±0.06, t=-15.08, P<0.01)), and remained significantly high in the chronic phase of epilepsy( 6 weeks (1.30±0.16, t=-10.40, P<0.01)). (2) The content of residual glutamate in the supernatant fluid of primary cell culture medium was detected.It was found that the uptake of glutamate by astrocytes in the NDRG2 -/- group was significantly lower than that in the NDRG2 + /+ group ((689.03±101.78) μmol/L, (113.67±37.35) μmol/L; t=9.19, P<0.01). (3) Western blot results showed that the expression of EAAT1 protein in NDRG2 -/- primary astrocyte was significantly lower than that of NDRG2 + /+ primary astrocyte(0.34±0.03, 1.16±0.21), and the difference was statistically significant ( t=-6.59, P<0.01). (4) Flow cytometry results showed that the positive rate of astrocyte in NDRG2 -/- group cells was significantly lower than that in NDRG2 + /+ group cells ((17.60±5.72)%, (72.22±8.35)%), and the difference was statistically significant ( t=-13.22, P<0.01). Conclusion:NDGR2 is closely related to the occurrence and development of epileptic diseases. The expression of NDRG2 is beneficial to exert its physiological function of EAAT1 and promotes the uptake of glutamate and glucose by astrocyte. It may be a potential cell protective factor to promote nerve protection and repairment.

Objective:To study the clinical characteristics of neonatal community-acquired Novel Coronavirus (COVID-19) Omicron variant infection.Methods:From March 30 to May 15, 2022, the epidemiological characteristics, clinical manifestations and outcomes of neonatal cases of community-acquired COVID-19 Omicron variant infection admitted to the isolation ward of our hospital were analyzed.Results:A total of 7 neonates infected with community-acquired COVID-19 Omicron variant were treated, including 3 males and 4 females. All of them were term infants with clear epidemiological exposure history. The infection was originated from caregivers of close contact (parents or babysitters). The main clinical symptoms was upper respiratory tract infection, including fever (6 cases), nasal congestion (6 cases), cough (5 cases), runny nose (2 cases), poor appetite (2 cases) and diarrhea (1 case). On admission, no abnormalities were found in blood routine examination and C-reactive protein (CRP). All but one case had normal serum amyloid A (SAA). No obvious abnormalities were found on chest X-ray. All patients were isolated in single-patient rooms after admission. They received standard symptomatic treatment and regular nucleic acid tests. The first negative nucleic acid results came on median 17 d(8~26 d) after the onset of the disease. The patients were discharged after two consecutive (24 h apart) nucleic acid tests with CT value ≥35 and continued health-monitor at home. On discharge, 5 patients had nasal congestion and 2 of them had cough. During the follow-up 4~6 weeks after discharge, all patients gradually recovered without positive nucleic acid results.Conclusions:All 7 neonates with community-acquired COVID-19 Omicron variant infection have epidemiological exposure history. The main clinical symptoms are long-lasting upper respiratory tract infections. It takes a relatively long time for the nucleic acid to turn negative, however, the overall short-term prognosis is good.

Objective To study the clinical features,diagnosis,genetic characteristics and treatment of congenital disorder of glycosylation type Ⅰg (CDG-Ⅰg) and to raise the awareness of CDG-Ⅰg among the clinicians.Method The data of one child with CDG-Ⅰg admitted to Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine was studied retrospectively.Literatures were retrieved with key words including "congenital glycosylation disorder Ⅰg","ALG12","congenital glycosylation defect Ⅰg","CDG-Ⅰg" and "congenital disorder" in the Chinese knowledge network,VP database,Wanfang database,Biomedicine,PubMed and the Web of Science database from data established until January 2018.We summarized the clinical and genetic characteristics of CDG-Ⅰg.Result An one-day-old male infant admitted to the Hospital due to "poor response with hypoglycemia" manifested with facial deformity,hypotonia,inverted nipples,micropenis and undescended testes.He had intermittent hypoglycemia and recurrent infection,treated with antimicrobials,glucose rehydration and hormone therapy.Serum insulin,growth hormone level,blood and urine metabolic screening were normal.The patient was compound heterozygous for ALG12 mutations,c.432C ＞ A,p.Cys144 * and c.904T ＞ C,p.Tyr302His,each of his parents carried a pathogenic mutation.The patient died in follow-up for unknown reasons.No reported cases of CDG-Ⅰg from China have so far been reported yet.We reviewed the other 8 cases CDG-Ⅰg (4 males and 4 females) born in foreign countries,5 of them with neonatal onset.Common clinical manifestaions include facial deformity,hypotonia,hypogenitalism,coagulopathy,hypoimmunity,recurrent infection,electroyte imbalance etc.The ALG12 gene has 11 mutation sites.Conclusion CDG-Ⅰg is a rare autosomal recessive disorder.Most reported patients had onset in neonatal period.It seems that the association of facial deformity,psychomotor retardation,hypotonia,coagulopathy,male hypogenitalism and hypoglycemia might be a clue to the diagnosis of CDG-Ⅰg.Gene detection of ALG12 can confirm the diagnosis.This disorder has no specific treatment yet.

In healthy individuals,there is a favourable balance between commensal and potentially patho-genic bacteria.When the balance is broken,the host might suffer from gastrointestinal cancer.Studies have shown that high-fat diet can alter the composition of gastrointestinal microbiota,gastrointestinal microbiota may promote gastrointestinal cancer by affecting metabolites of gastrointestinal microbiota,leading to loss of gastrointestinal barrier function,suppressing anti-tumor immunity,etc.In this work,we will summary the current knowledge on relations and possible mechanisms of high-fat diet-associated gastrointestinal microbiota and gastrointestinal cancer.To provide new ideas for the treatment of gastrointestinal cancer.

OBJECTIVETo perform theory construction and empirical study of the competency model of rural general practitioners.

METHODSThrough literature study, job analysis, interviews, and expert team discussion, the questionnaire of rural general practitioners competency was constructed. A total of 1458 rural general practitioners were surveyed by the questionnaire in 6 central provinces. The common factors were constructed using the principal component method of exploratory factor analysis and confirmatory factor analysis. The influence of the competency characteristics on the working performance was analyzed using regression equation analysis.

RESULTSThe Cronbach 's alpha coefficient of the questionnaire was 0.974. The model consisted of 9 dimensions and 59 items. The 9 competency dimensions included basic public health service ability, basic clinical skills, system analysis capability, information management capability, communication and cooperation ability, occupational moral ability, non-medical professional knowledge, personal traits and psychological adaptability. The rate of explained cumulative total variance was 76.855%. The model fitting index were Χ(2)/df 1.88, GFI=0.94, NFI=0.96, NNFI=0.98, PNFI=0.91, RMSEA=0.068, CFI=0.97, IFI=0.97, RFI=0.96, suggesting good model fitting. Regression analysis showed that the competency characteristics had a significant effect on job performance.

CONCLUSIONSThe rural general practitioners competency model provides reference for rural doctor training, rural order directional cultivation of medical students, and competency performance management of the rural general practitioners.

Objective:To study the predictive value of hour-specific total serum bilirubin(TSB) nomogram combined with clinical risk factors in the risk of hyperbilirubinemia.Method:Perinatal clinical data of newborns born in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai Pudong New Area People's Hospital and Shanghai Pudong Hospital from August 2017 to July 2018 were collected in this prospective study. Transcutaneous bilirubin (TcB) was monitored before discharge from hospital. Enrolled neonates were followed up for 28 days. The patients were assigned to neonatal hyperbilirubinemia group (NHB) and non-hyperbilirubinemia group (Non-HB) according to the occurrence of hyperbilirubinemia. The predictive value of models for the risk of hyperbilirubinemia was evaluated by receiver operating characteristic (ROC) curves and Logistic regression analysis.Result:A total of 8 664 newborns were included in this study, with 1 196 cases of hyperbilirubinemia, with an incidence of 13.8%. Logistic regression analysis showed that maternal blood type O, premature rupture of membranes, male gender, gestational age 35~37 weeks, subcutaneous ecchymosis/cranial edema, and breastfeeding were independent risk factors for NHB ( P<0.05). The area under receiver operative characteristic curve (ROC) of predischarge bilirubin risk zone only was 0.874(95% CI 0.861~0.885, P<0.05)and for all independent risk factors was 0.664 (95% CI 0.647~0.680, P<0.05). The area under ROC curve was 0.891 (95% CI 0.880~0.902, P<0.05) by combining predischarge bilirubin risk zone with clinical risk factors. Conclusion:Predischarge bilirubin risk zone combined with clinical risk factors can reasonably predict neonatal hyperbilirubinemia well.

Objective:To analyze the clinical features, treatment, and outcomes of fetal/neonatal atrial flutter (AFL) at the onset of the perinatal period to improve the management of this condition.Methods:This retrospective study analyzed the clinical data, treatment, and follow-up results of fetal/neonatal AFL cases transferred to Shanghai Children's Medical Center from November 2013 to August 2021. Clinical characteristics, cardioversion procedures, and outcomes were summarized. Descriptive method was used for statistical analysis.Results:A total of 21 fetuses/neonates presenting with AFL in the perinatal period were involved in this study, including 17 males and four females. Ten of them were born at full term, and 11 were preterms. All of the patients were delivered by cesarean section at 32 to 41 gestational weeks [ (36.6±1.9) weeks] with a birth weight of 2 130 to 4 450g [ (3 059±528) g]. Increased fetal heart rate was all detected after 32 weeks of gestation, and three of them were diagnosed with AFL by fetal echocardiography before being born. The heart rate remained elevated in all cases after birth. All were diagnosed as AFL based on an electrocardiogram on the day of birth, which showed a 2 to 6 over one ratio of atrioventricular conduction. Among the six cases of cardiac insufficiency and low blood pressure complicated by dyspnea and cyanosis, the symptoms were relieved in four cases after mask oxygenation and two cases after ventilation. Among the 21 cases, one was converted spontaneously to normal sinus rhythm and the other 20 recovered after medication or electrical cardioversion. Seven cases were initially treated by drug conversion with a success rate of 5/7 and hospitalized for 23 d (13-25 d). There was one with cardiac insufficiency before treatment and three newly developed cardiac insufficiency during treatment among the seven cases. Thirteen cases were offered electrical cardioversion initially, and the success rate of cardioversion was 12/13. There were five cases of cardiac insufficiency before treatment, while no new cases of cardiac insufficiency was reported during treatment. The duration of hospitalization was 11 d (9-14 d). Apart from one case, the rest 20 infants were followed up from one month to eight years old, and no recurrence was reported.Conclusions:For fetal/neonatal AFL with the onset during the perinatal period, the symptoms mainly manifest in late pregnancy. Its diagnosis depends on fetal echocardiography before birth or electrocardiogram after birth, and electrical cardioversion is a fast and effective measure. While the prognosis of perinatal-onset AFL is generally good.