Objective To assess the cost-benefit of exchange transfusion(ET ) in the treatment of different severity of acute bili-rubin encephalopathy(ABE) .Methods Retrospective analysis was carried out on the clinical data of 137 ABE from January 2009 to December 2010 .The enrolled neonates were divided into four groups by ABE severity and interventions :40 neonates in Group SE (Subtle ABE with ET ) ,29 in Group SNE (Subtle ABE without ET ) ,49 in Group ME (Moderate to advanced ABE with ET ) ,and 19 in Group MNE (Moderate to advanced ABE without ET ) .Results The Total Serum Bilirubin (TSB) levels ,the ratio of TSB and plasma albumin (B/A) ,the proportion of neonatal hemolysis disease and the hospitalization costs per capita in Group SE were significantly higher than those in Group SNE (P<0 .05) .Without death in subtle ABE ,the rate of poor outcomes in Group SE , 15 .0% was similar to that of Group SNE ,13 .8% .The maximum benefit-cost ratio of Group SE and Group SNE was 87 .5 and 121 .5 ,respectively .The TSB levels ,B/A ,the proportion of neonatal hemolysis disease and the hospitalization costs per capita in Group ME significantly higher those in Group MNE (P<0 .05) .5 neonates died in moderate to advanced ABE ,and the incidence of poor outcomes in Group ME ,32 .7% was 2 .1 times to that of Group MNE ,15 .8% .The maximum benefit-cost ratio of Group ME and Group MNE was 89 .8 and 160 .0 ,respectively .The TSB levels and B/A in Group ME significantly higher those in Group SE (P<0 .05) ,the incidence of poor outcomes in Group ME was 2 .2 times to that of Group SE ,whereas the hospitalization costs per capita in Group ME were similar to those in Group SE (P>0 .05) .Morbidity of the severe adverse events associated with ET in Group ME ,12 .2% was 2 .4 times to that of Group SE ,5 .0% .Conclusion ET is worth of the first-line approach rescuing subtle ABE .However ,ET is needed to be weighted the advantages and disadvantages before performed on moderate or advanced ABE .It is necessary to implement phototherapy among neonates with pathologic jaundice ,which is crucial for diminishing mortality and mor-bidity of ABE and lowering medical resource consumption .

Objective To investigate the expression of Dickkopf-3 (DKK3) in human malignant melanoma cell lines and tissues,and to evaluate effects of DKK3 on the proliferation and apoptosis of malignant melanoma cell line A375.Methods Reverse transcription PCR (RT-PCR) and real-time fluorescence-based quantitative PCR (qRT-PCR) were performed to measure the mRNA expression of DKK3 in human malignant melanoma cell lines HM,A375,WM451,WM35,SK-MEL-1,Hs-695T and MDA-MB-435s,as well as in 38 primary melanoma tissues,4 metastatic melanoma tissues and 20 pigmented nevus tissues.Cultured malignant melanoma A375 cells were divided into 2 groups to be transfected with pcDNA3.1 (+)-Flag-DKK3 (experiment group) and pcDNA3.1 (+)-Flag-Vector (control group) respectively.The overexpression of DKK3 was verified by RT-PCR.Cell counting kit-8 (CCK8) assay and plate colony formation assay were performed to evaluate the proliferative activity of A375 cells,flow cytometry was conducted to detect apoptosis of A375 cells,and Western blot analysis was performed to determine the expression of cell cycle-and cell apoptosis-related proteins.Results The mRNA expression of DKK3 was downregulated in WM35 cells,absent in HM cells,A375 cells,WM451 cells,SK-MEL-1 cells and Hs-695T cells,but upregulated in MDA-MB-435s cells.Compared with pigmented nevus tissues,the mRNA expression of DKK3 was significantly decreased in malignant melanoma tissues (P ＜ 0.001).Compared with the control group (100％),cell colony formation was markedly suppressed in the experiment group (23.22％ ± 3.55％),and the proliferative activity of A375 cells was also significantly inhibited in the experiment group 24,48,72 hours after the transfection (all P ＜ 0.05).Flow cytometry showed that compared with the control group,A375 cells were significantly arrested in G1 phase (48.68％ ± 3.92％ vs.25.38％ + 2.92％,P ＜ 0.001),and the apoptosis rate of A375 cells was significantly increased in the experiment group (P ＜ 0.001).Compared with the control group,the experiment group showed significantly higher expression of p21,Bax,cleaved-parp and cleaved-casp3,but significantly lower expression of cyclin D1 and Bcl2 (all P ＜ 0.001).Conclusion DKK3 expression is downregulated in human malignant melanoma tissues,so it may serve as a potential tumor suppressor gene involved in the development of cutaneous malignant melanoma.

Objective To study the risk factors of severe complications possibly associated with exchange transfusion (ET) for patients with extreme hyperbilirubinemia.Method From May 2001 to May 2018,neonates with severe complications of ET were assigned into adverse event group.The propensity score principle was used to match adverse event group/the control group with the ratio of 1 ∶ 3.The neonates in the control group received ET without any severe complications.The demographic characteristics of patients,and other clinical data were reviewed.The Logistic regression analysis was used to determine the risk factors of severe complications of ET.Result Among the 1 535 neonates who received ET during the past 17 years,71 neonates (4.6％) were identified with severe adverse events,including apnea (30.6％),necrotizing enterocolitis (18.8％),heart failure (14.1％),respiratory failure (12.9％),and shock (8.2％).The Logistic regression analysis showed that acute bilirubin encephalopathy (ABE) score ≥ 3 (OR=6.383,95％CI 2.550～15.979),ETs ≥ 2 times (OR=11.825,95％CI 2.464～56.755),cardiac murmur ≥ grade Ⅲ (OR=20.417,95％CI 4.705～40.590),and dramatic blood pressure fluctuation during ET ≥ 30 mmHg (OR=13.612,95％CI 1.795～43.342) were risk factors of ET related severe complications (all P＜0.05).Conclusion The indications should be carefully assessed before ET.The patients with ABE score ≥ 3,ETs ≥ 2 times,cardiac murmur ≥ grade Ⅲ,or dramatic blood pressure fluctuation during ET ≥ 30 mmHg should be monitored carefully and ET should be stopped in time if necessary.

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.