Objective To explore the risk factors and outcomes associated with pulmonary hemorrhage in very low and extremely low birth weight infants.Methods Retrospective analysis were performed to predict risk factors for pulmonary hemorrhage in very low and extremely low birth weight infants (birth weight less than 1200g) admitted to NICU of Shengjing Hospital from Jan.2010 to Dec.2015.Infants at similar birth weight without pulmonary hemorrhage were as controls.We compared the characteristics of both maternal and infants.Multivariable Logistic regression models were derived to predict pulmonary hemorrhage.Short outcomes of the infants were assessed.Results Of the 435 neonates,71 developed pulmonary hemorrhage (pulmonary hemorrhage group),364 were as controls (control group).Gestational age[(28.2±1.7)week],birth weight[(936±192)g] in pulmonary hemorrhage group were significantly lower than those in control group[(29.5±2.1)week,(1033±134)g,t=4.776,5.145,P<0.01].Neonatal respiratory distress syndrome(RDS)(76.1%),pulmonary surfactant (PS)use(PS use≥2 courses)[76.1%(9.9%)],patent ductus arteriosus (PDA)(66.2%)were significantly higher than those in control group[41.2%,30.8%(4.1%),38.7%;χ2=33.457,28.970(4.074),32.798,P<0.05].Antenatal corticosteroids utility ratio (21.1%)was lower than that in the control group (41.2%;t=10.177,P< 0.001).Multiple factors Logistic stepwise regression analysis showed that RDS (OR=3.739,95%CI 1.383-10.113,P<0.05 ),PDA (OR=2.206,95%CI 1.205-4.093,P<0.05),and 5 minutes Apgar score <7(OR=2.851,95%CI 1.191-6.828) were independent risk factors of pulmonary hemorrhage,and higher birth weight (OR=0.998,95%CI 0.996-1.000,P<0.05) and the use of antenatal corticosteroids (OR=0.432,95%CI 0.224-0.834,P<0.05) were the protection factors in pulmonary hemorrhage.In pulmonary hemorrhage group,the incidence of intracranial hemorrhage,retinopathy of prematurity and severe bronchopulmonary dysplasia(16.9%,12.7% and 18.3%) were significantly higher than those in control group (5.8%,4.4% and 2.2%;χ2=36.824,7.520 and 33.568,P<0.01);Compared to control group,the mortality in pulmonary hemorrhage group was higher (49.3% vs.14.0%;χ2=46.634,P<0.01).Conclusion Pulmonary hemorrhage in very low and extremely low birth weight infants is associated with multiple factors.Prevention of premature birth and prenatal corticosteroids treatment can help prevent the occurrence of pulmonary hemorrhage.The incidences of poor outcomes are higher in newborns with pulmonary hemorrhage.

[Objective]To explore the efficacy of T2* mapping for evaluating inflammatory activity in the patients with Crohn disease(CD).[Methods]A total of 98 CD patients underwent MR enterographywith T2*WI. T2* values were measured by put-ting regions of interest on the thickening bowel wall on T2*mapping. The activity of bowel segment was scored by magnetic resonance index of activity(MaRIA),to analyze the relationship between T2*values with CD activity.[Results]A total of 160 bowel segments were evaluated and includedinactive(MaRIA<7,n=26),mild(7≤MaRIA<11,n=23),and moderately-severe(MaRIA≥11, n = 111)active lesions. The differences in T2* values amongthese three groups were significant(all P < 0.05). T2* values of 160 bowel segments correlatedclosely withMaRIA(r=0.743,P<0.05). High accuracy of T2*values was shown for differentiating inac-tive from active CD(AUC=0.877)anddifferentiating inactive-mild from moderate-severe CD(AUC=0.848). The threshold T2*value of 20 ms allowed differentiation of mild from moderate-severe CD with74.5%sensitivity and 84%specificity.[Conclusions]T2*values, as thequantitative indexof T2*mapping,correlate well with CD activity and showsatisfiedefficacy for diagnosing inflammatoryactivity.

Objective To explore the risk factors and short outcomes associated with late-onset sep-sis (LOS) in very low and extremely low birth weight infants.Methods Retrospective analysis were per-formed to predict risk factors for LOS in very low and extremely low birth weight infants (birth weight less than 1 200 g) admitted to NICU of Shengjing Hospital from Jan 2010 to Dec 2015.Infants with similar birth weight without LOS were as controls.We compared the characteristics of maternal and neonatal periods in both groups.Multivariable Logistic regression models were derived to predict LOS sepsis.Short outcomes of the infants were assessed.Results Total of 381 very low birth weight infants were admitted during the study period.LOS occurred in 138 infants(36.2%,138/381),who developed sepsis at a mean age of (19.8 ± 11.0)days;the mean gestational age,birth weight and hospitalization time were(29.4 ± 2.1)week,1 064 (953,1 126)g and 55(43,72)d.Other 243 cases were control,mean gestational age,brith weight and hospi-talization time were(29.3 ± 2.0)week,1 060(955,1 144)g and 49(37,63)d.Ninety-seven cases had posi-tive blood culture(70.3%,97/138) in LOS group.Out of the 138 cases of LOS,8 cases(5.8%,8/138) died from their sepsis with a positive blood culture.Infants with LOS were more likely to have a long-term use of ventilation and peripherally inserted central catheteh(PICC),the failure of early enteral feeding,delayed com-plete enteral feeding time and the longer hospital stays compared to uninfected infants.Multivariate Logistic regression analysis showed that long-term use of PICC(OR 1.039,95%CI 1.012-1.067,P=0.004)was an independent risk factor for LOS in very low birth weitht infants. Septic infants,compared with nonseptic infants,had significantly more serious morbidity,including white matter damage(20.3% vs.10.3%),necro-tizing enterocolitis(9.4% vs.2.9%),retinopathy of prematurity(10.9% vs.3.7%),and cholestatic jaun-dice(19.6% vs.11.9%)(P<0.05).Conclusion A number of factors are related to LOS.LOS is associated with poor prognosis of preterm infants.Long-time PICC is a risk factor for LOS.

Objective:To review the experience of closure of the left-main-bronchial stump fistula using endoscopic liner cutter staplers through the right thoracic approach and I stage or staged treatment for the left pyothorax.Methods:6 patients with the left-main-bronchial stump fistula after left pneumonectomy combined with pyothorax were treated by closing the left-main-bronchial stump using endoscopic liner cutter staplers through the right thoracic approach, and pleura was used to cover the distal and proximal incisional margin of the stump respectively. The thoracic T-tube drainage was used in the I stage or staged treatment for the left pyothorax.Results:All patients were survived without recurrence of the bronchopleural fistula. 4 patients were observed to have no recurrence of pyothorax when 1 patient had recurrence of pyothorax and was treated with intermittent T-tube drainage.1 patient operated with left-thoracic fenestration in the past was treated with drainage waiting for secondary operation.Conclusion:The right thoracic approach seemed to be a safer and more effective method than the transsternal transpericardial approach in cases with the left-main-bronchial stump fistula combined with pyothorax. The use of endoscopic liner cutter staplers reduced the risk of bleeding, infection and recurrence of fistula. The T-tube drainage in the I stage or staged treatment for the left pyothorax was considered to be an easier way for treatment.

Objective:To understand the current state of financial toxicity and suicide risk in head and neck cancer patients, to investigate the correlation between the level of financial toxicity and suicide risk in head and neck cancer patients, and to provide a basis for reducing the level of financial toxicity and the risk of suicide in head and neck cancer patients.Methods:A cross-sectional survey was conducted, from March 1 to July 31, 2022, 150 head and neck cancer patients were selected from Oncology Department of East Hospital Affiliated to Tongji Universityby by convenient sampling method. The survey was carried out by means of the general questionnaire, Comprehensive Score for Financial Toxicity based on the Patient-Reported Outcome Measures (COST-PROM), Cancer Suicide Risk Scale (CSRS), and then analysis the datum.Results:The score of COST-PROM of 150 head and neck cancer patients was (18.00 ± 6.12) points, and the score of CSRS of head and neck cancer patients was (36.31 ± 8.51) points. The total score of economic toxicity was significantly negatively correlated with the total score of suicide risk and its dimensions ( r values were -0.446 to 0.235, all P<0.05). The total score of suicide risk was negatively correlated with the total score of economic toxicity and the scores of each dimension ( r values were -0.446 to -0.251, all P<0.05). Conclusions:Patients with head and neck cancer were at higher risk of suicide, and financial toxicity was a significant contributing factor to suicide risk, with higher levels of financial toxicity associated with a higher risk of suicide. Reducing the level of financial toxicity in patients with head and neck cancer has important implications for reducing their risk of suicide.

Objective To assess the diagnostic value of magnetization transfer MRI (MTI) for bowel inflammation and fibrosis in humans with Crohn disease (CD). Methods From July 2014 through April 2017, 31 patients with a confirmed diagnosis of CD were prospectively recruited from the First Affiliated Hospital of Sun Yat Sen University. They were scheduled for elective surgery due to bowel obstruction and other complications, and underwent preoperative MR enterography (MRE) and MTI within 15 days of surgery. All cases had available intestinal specimens identified on MRE and resected bowel segments for region by region matching. All patients underwent breath hold conventional MRE and MTI examinations, and then the magnetization transfer ratios (MTRs) of pathological bowel segments were measured. Using region by region correlation between MTI and surgical specimen, the bowel segments were resected to stain with HE for evaluating bowel inflammation, Masson for bowel fibrosis, and typeⅠcollagen staining for the deposition of typeⅠcollagen within the bowel walls. The histologic sections from the most severe areas were scored as 0 (normal), 1 (mild), 2 (moderate) and 3 (severe). The correlations between MTR and histologic scores were analyzed by using Spearman rank correlation or partial correlation. The differences in MTR among different grades of bowel fibrosis were analyzed by one way ANOVA. The efficacy of MTR for predicting bowel fibrosis was evaluated by receiver operating characteristic curves analysis. The difference in MTRs between purely inflammatory bowel walls and mixed fibrotic and inflammatory bowel walls was analyzed by Student s t test. Results Sixty two resected bowel specimens from 31 patients including 9 purely inflammatory bowel walls and 53 mixed fibrotic and inflammatory bowel walls were obtained in this study. There were significant differences in MTR among non fibrotic [(21.45 ± 2.65)%], mildly [(30.88 ± 6.14)%], moderately [(35.14 ± 4.31)%] and severely [(35.14 ± 4.31)%] fibrotic walls (F=38.397,P<0.01). MTRs strongly correlated with fibrosis scores (r=0.681, P<0.01). High accuracy of MTRs was shown (curve under area=0.905, P<0.01) for differentiating moderately severely fibrotic from non fibrotic and mildly fibrotic bowel walls. Using MTR of 31.50% as a cutoff value, the sensitivity and specificity were 93.6% and 80.0%, respectively. The MTRs of purely inflammatory bowel walls [(21.45 ± 2.65)%] were significantly higher than that of mixed fibrotic and inflammatory [(36.28±5.21)%] bowel walls (t=-13.052,P<0.01). MTRs correlated with the scores of type Ⅰ collagen (r=0.325, P=0.044) but did not correlate with inflammation scores (r=-0.024, P=0.857). Conclusions MTI enables quantitative evaluation of bowel fibrosis in patients with CD and can be used to differentiate purely inflammatory CD from mixed fibrotic and inflammatory CD.

Objective To determine the correlation between intravoxel incoherent motion (IVIM) parameters and both histologic inflammatory and fibrotic grades of Crohn disease (CD) in adults. Methods Prospectively, 17 patients (77 lesions) with a clinical and pathological diagnosis of CD in the first affiliated hospital of sun yat-sen university from July 2015 to June 2016 underwent MRE 15 days before surgery. All patients underwent T2WI, IVIM and enhanced MRI and calculated IVIM parameters include diffusion-related coefficient (D), perfusion-related coefficient (D*) and perfusion-related fraction (f). Histological intestinal inflammation and fibrosis was scored using the surgical histopathology as reference standard and further divided into mild-moderate (score 1 to 2) and severe (score 3 to 4) groups. Intestinal microvessel density (MVD) were also analyzed. Differences in IVIM parameters among different histological inflammation and fibrosis grades were assessed with the Kruskal-Wallis test. The Wilcoxon test was used for assessing differences in f between mild-moderate and severe fibrosis. The bivariate correlations between IVIM parameters and histological inflammation and fibrosis grades were analyzed using partial correlation . The bivariate correlations between IVIM parameters and MVD were analyzed using Spearman rank correlation. The areas under the receiver operating characteristics curves (AUROC) were analyzed to evaluate the efficacy for distinguishing severe from mild-moderate fibrosis. Results Of 77 surgical specimens, there were 41 mild-moderate and 36 severe inflammatory bowel segments, along with 22 mild-moderate and 55 severe fibrotic bowel segments. Positive correlation was shown between histologic inflammatory and fibrotic scores (r=0.592, P<0.01). MVD (42.7 ± 39.9)/HP presented weak positive correlation with histologic inflammatory scores (r=0.332, P=0.003) while no correlation with histologic fibrotic scores (r=0.129, P=0.262) was presented. Neither the D nor the D* values significantly correlated with histologic inflammation or fibrosis (P>0.05) while the f value significantly correlated with both histologic inflammation and fibrosis (P<0.05). Significant correlation was present between the f value and histologic inflammatory and fibrotic scores, respectively (r=-0.280, -0.520;P<0.05). There was significant difference in the f value between mild-moderate and severe fibrosis(Z=-5.255,P<0.01). The AUROC for the f value to distinguish between patients with mild-moderate fibrosis and severe fibrosis were 0.885. Using a threshold fractional perfusion of 0.33, the sensitivity and specificity values were 95.5％ and 81.8％, respectively. No correlation between f, D and D*value with histologic fibrotic scores (r=0.129, P=0.262) was presented. Conclusion The f value derived from IVIM could help to evaluate the severity of intestinal inflammation and fibrosis CD in adults.

Objective To investigate the effect of astrocyte-derived microparticles on intracellular free calcium concentration in umbilical vein endothelial cells (UVECs).Methods Brain astrocytes were first isolated from 24 h new-born Sprague-Dawley rats and cultured in vitro.Then,they were stimulated with calcium ionophore,A23187,and microparticles were extracted by fractional centrifugation and verified by electron microscopy.UVECs cultured in vitro were divided into control group,nimotop group,and low,median and high concentrations ofmicroparticles groups;cells from nimotop group were pretreated with 10 μL nimotop for 10 min;cells from the later 4 groups were given 1×108,0.5×108,1×108,and 2× 108/mL microparticles respectively;cells from the control group were given the same volume of medium.Ten min after cultivation,they were loaded with fluorescent probe Fluo3-AM,respectively.Later,the concentration of Ca2+ in UVECs was measured by confocal laser scanning microscope and flow cytometry.Results The isolation and in vitro culture methods for rat astrocytes provided stable and reliable results.With A23187 stimulation and fractional centrifugation,astrocyte derived microparticles were available for extraction.Laser scanning confocal microscope indicated that the intracellular fluorescence intensity in the control group was the lowest;after incubating UVECs with low,median and high concentrations of astrocyte-derived microparticles,the intracellular fluorescence intensity increased,and it increased following the concentrations of astrocyte-derived microparticles;pretreatment with nimotop could moderately decrease the intracellular fluorescence intensity,but that in the nimotop group was still higher than that in the control group.The mean fluorescence values for intracellular free Ca2+ were 51 866,57 996 and 73 630,respectively,in the low,median and high concentrations of microparticles groups,which showed statistically significant increase as compared with that from the control group (45 759,P＜0.05).When nimotop was applied to the cells,it blocked the influx of calcium ions and the measured value was significantly changed to 49843,enjoying significant difference as compared with that from the low,median and high concentrations of microparticles groups (P＜0.05).Conclusion Astrocyte-derived microparticles are capable of increasing the intracellular free calcium concentration in UVECs,and the effects can be blocked by nimotop.

ObjectiveTo explore the pharmacodynamic effect of the water extract of Citri Grandis exocarpium （WEC） on mice with alcohol-induced acute liver injury and provide data support for the development of this medicinal for anti-alcoholism and liver protection. MethodThe main components of WEC were determined by high performance liquid chromatography （HPLC）. Sixty Balb/c mice were randomized into 6 groups： control group （equal volume of 0.5% carboxymethyl cellulose sodium solution）， model group （equal volume of 0.5% carboxymethyl cellulose sodium solution）， low-， medium-， and high-dose WEC groups （0.5， 1.0， 2.0 g·kg^-1）， and Haiwang Jinzun tablet positive control group （2.0 g·kg^-1）. The administration lasted 14 days. One day before the end of the administration， mice were fasted for 12 h with free access to water. The mice， except the control group， were given 56° Chinese liquor （13 mL·kg^-1）. After 2 h， blood was taken from eyeballs and the liver was dissected and weighed. Automatic biochemical analyzer was employed to detect the expression of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， and alcohol dehydrogenase （ADH）. The pathological changes of liver tissues were observed based on hematoxylin-eosin （HE） staining， and apoptosis of hepatocytes based on TUNEL/DAB staining. The expression of proteins related to apoptosis was detected by Western blot. ResultAccording to the HPLC fingerprint， the main components of WEC were rhoifolin and naringin. Compared with the control group， the model group showed increase in liver/body weight ratio （P<0.01） and the expression of ALT and AST （P<0.05， P<0.01）， decrease in the expression of ADH （P<0.05）， blurred structure of hepatic lobules， pathological changes of liver tissue， loose cytoplasm with edema， severe steatosis， rise of the TUNEL-positive rate （P<0.01）， reduction in expression of Bcl-2 （P<0.01）， and increase in Bax and Caspase-3 （P<0.01）. Compared with the model group， medium-dose WEC lowered liver/body weight ratio （P<0.05）. All doses of WEC depressed the activity of ALT and AST （P<0.05， P<0.01）， up-regulated the expression of ADH （P<0.05）， significantly improved the pathological features of alcohol-induced cytoplasmic porosity， edema， and steatosis， down-regulated the TUNEL-positive rate （P<0.05， P<0.01）， enhanced the expression of Bcl-2 （P<0.05）， and decreased Bax and Caspase-3 （P<0.01）. ConclusionWEC regulates the expression of ALT， AST， and ADH and improves hepatic steatosis and hepatocyte apoptosis to fight against acute liver injury.

Myopia is becoming more and more common all over the world, and the incidence of myopia is gradually increasing. Many treatments have been used to prevent and control myopia, including optics, drugs, environment or behavior, but the results are different and lack standardization. At present, many experiments have proved that peripheral defocus technology has a certain effect on myopia control. Based on this technology, three kinds of framed eyeglass lenses with peripheral defocus design, namely defocus incorporated multiple segments(DIMS), highly aspherical lenslets(HAL)and cylindrical annular reactive elements(CARE), are commonly used in medical and optometry institutions in China. These lenses provide not only clear vision in the central area, but also a certain amount of myopic defocus in the periphery to control the progression of myopia. This paper aims to focus on the design principle and myopia prevention and control effect of the above three peripheral defocus lenses, and evaluate their effectiveness in clinical practice.