Objective: To investigate the incidence and trend of short-term outcomes among preterm infants born <34 weeks' gestation. Methods: A secondary analysis of data from the standardized database established by a multicenter cluster-randomized controlled study "reduction of infection in neonatal intensive care units (NICU) using the evidence-based practice for improving quality (REIN-EPIQ) study". This study was conducted in 25 tertiary NICU. A total of 27 192 infants with gestational age <34 weeks at birth and admitted to NICU within the first 7 days of life from May 2015 to April 2018 were enrolled. Infants with severe congenital malformation were excluded. Descriptive analyses were used to describe the mortality and major morbidities of preterm infants by gestational age groups and different admission year groups. Cochran-Armitage test and Jonckheere-Terpstra test were used to analyze the trend of incidences of mortality and morbidities in 3 study-years. Multiple Logistic regression model was constructed to analyze the differences of outcomes in 3 study-years adjusting for confounders. Results: A total of 27 192 preterm infants were enrolled with gestational age of (31.3±2.0) weeks at birth and weight of (1 617±415) g at birth. Overall, 9.5% (2 594/27 192) of infants were discharged against medical advice, and the overall mortality rate was 10.7% (2 907/27 192). Mortality for infants who received complete care was 4.7% (1 147/24 598), and mortality or any major morbidity was 26.2% (6 452/24 598). The incidences of moderate to severe bronchopulmonary dysplasia, sepsis, severe intraventricular hemorrhage or periventricular leukomalacia, proven necrotizing enterocolitis, and severe retinopathy of prematurity were 16.0% (4 342/27 192), 11.9% (3 225/27 192), 6.8% (1 641/24 206), 3.6% (939/25 762) and 1.5% (214/13 868), respectively. There was a decreasing of the overall mortality (P<0.001) during the 3 years. Also, the incidences for sepsis and severe retinopathy of prematurity both decreased (both P<0.001). However, there were no significant differences in the major morbidity in preterm infants who received complete care during the 3-year study period (P=0.230). After adjusting for confounders, infants admitted during the third study year showed significantly lower risk of overall mortality (adjust OR=0.62, 95%CI 0.55-0.69, P<0.001), mortality or major morbidity, moderate to severe bronchopulmonary dysplasia, sepsis and severe retinopathy of prematurity, compared to those admitted in the first study year (all P<0.05). Conclusions: From 2015 to 2018, the mortality and major morbidities among preterm infants in Chinese NICU decreased, but there is still space for further efforts. Further targeted quality improvement is needed to improve the overall outcome of preterm infants.
Bronchopulmonary Dysplasia/epidemiology* ; Gestational Age ; Humans ; Infant ; Infant Mortality/trends* ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/epidemiology* ; Patient Discharge ; Retinopathy of Prematurity/epidemiology* ; Sepsis/epidemiology*

Objective:To study the risk factors of hemodynamically significant patent ductus arteriosus (hsPDA) in extremely preterm infants (EPI).Method:From July 2017 to April 2020, EPI (gestational age <28 weeks) admitted to the Department of Neonatology of our hospital were included and analyzed retrospectively. According to whether hsPDA existed or not, the infants were assigned into non-hsPDA group and hsPDA group. Demographic findings and possible risk factors of hsPDA were collected.The cumulative fluid overload (FO) within 3 days after birth was calculated. Univariate and multivariate analysis were used to determine the risk factors of hsPDA.Result:A total of 79 infants with gestational age of (27.0±0.9) weeks and birth weight of (987±173)g were enrolled, including 23 cases in non-hsPDA group and 56 cases in hsPDA group. Univariate analysis showed that thrombocytopenia ( P=0.044), respiratory distress syndrome (RDS) treated with pulmonary surfactant (PS) ( P=0.006) and high FO level ( P=0.002) were associated with hsPDA. Multivariate analysis showed that RDS treated with PS ( OR=5.933, 95% CI 1.360~25.883, P=0.018) and high FO level ( OR=1.261, 95% CI 1.063~1.496, P=0.008) were independent risk factors for hsPDA in EPIs. ROC curve analysis showed that the cut-off value of FO was -0.2%, with 85.7% sensitivity and 56.5% specificity distinguishing the presence of hsPDA (AUC=0.712, Youden index=0.422). Conclusion:High level of FO within the first 3 days of life and RDS treated with PS are independent risk factors for hsPDA in EPI. After PS treatment, hemodynamic changes of infants with RDS should be monitored closely. During early fluid management of EPI, FO should be strictly monitored to avoid high FO level.

Objective:To analyze and determine heavy metal content in Paridis Rhizoma from different genus and localities,in order to provide a reference for selecting cultivation areas and establishing the quality standard of Paridis Rhizoma of heavy metals content. Method:Microwave digestion method combined with inductively coupled plasma atomic emission spectrometry method (ICP-AES) method were applied to determine the contents of 6 heavy metals,i.e. As,Cu,Hg,Cd,Pb and Cr in 39 samples of Paridis Rhizoma of different genus and localities in Yunnan Province. Cluster analysis,statistical analysis and principal component analysis (PCA) were used to compare the differences of heavy metals contents in different localities and species. Result:The contents of six heavy metals in Paridis Rhizoma met the ISO international standard of Heavy Metal Limit of Traditional Chinese Medicine-traditional Chinese Medicinal Materials. Under the limited value standard of Green Trade Standards of Importing Medicinal Plants and Preparations,the over-standard rate of heavy metal As was 15.4%,the excess rate of Cd was 5.1%,and the excess rate of Pb was 2.6%. The contents of Cu and Hg conformed to relevant requirements. Cluster analysis,statistical analysis and principal component analysis showed that for the same variety,differences in producing places had significant effects on heavy metal content,while differences in species had little effects. Conclusion:The results of this study indicated that the heavy metal content of Paris planted in and around Dali basically conformed to relevant standards. The differences of heavy metal content in Paris were mainly regional differences,which provided a theoretical basis for standardizing the cultivation of medicinal materials and formulating the limit standards of heavy metals for Paridis Rhizoma.

Objective To investigate the safety and effectiveness of left internal mammary artery (LIMA) angiography via right transradial approach with 5F universal coronary angiography catheter. Methods Left internal mammary artery (LIMA) angiography via right transradial approach with 5F universal coronary angiography catheter was performed following coronary angiography in 86 patients.The success rate of the procedure, the result of LIMA angiography, the time to LIMA, the volume of contrast, the incidence of complications and bypass vessels in patients who received coronary artery bypass grafting (CABG) were recorded and analysed. Results The success rate was 97.6%(84/86), and the result of LIMA angiography was satisfied; the time to LIMA was (6.5 ± 2.8) min, and the volume of contrast was (17.6 ± 11.1) ml;the incident of complications was 4.7%(4/86);56 patients received CABG. LIMA was harvested in all cases and left radial artery in 53 cases. Conclusions LIMA angiography via right transradial approach with 5F universal coronary angiography catheter is safe and effective, and it has significant sense to patients who will receive CABG.

Debridement is an indispensable step in repairing of burn wounds. Hydrosurgery system is an advanced instrument for debridement. Compared with the conventional debridement instruments, the hand-piece of hydrosurgery system is more facile and easy to be controlled, which is helpful for the debridement of wounds with irregular shape and uneven surface; besides, hydrosurgery system combines necrotic tissue resection and wound perfusion simultaneously, and its debridement process is highly tissue-selective, which is helpful to improve the wound-bed and to create favorable conditions for skin grafting and wound healing. Hydrosurgery system has been used in burn wounds debridement for more than 10 years. It is widely used abroad and has been introduced to China in recent years. Due to the complexity of burn wounds, there are also many different opinions about the clinical use of hydrosurgery system for different wounds, including debridement efficiency, effect, cost and the amount of bleeding. In this paper, we systematically summarized the effect of hydrosurgery system on the debridement of burn wounds, so as to provide reference for clinicians.

Objective The aim of the study was to evaluate the association of fasting plasma glucose (FPG) level over 5.3 mmol/L to the development of abnormal glucose metabolism and cardiovascular diseases (CVD).Methods This was a retrospective cohort study with 1 064 non-diabetic subjects(980 males;84 females) aged 60 or over, who carried out annual health check-up in Chinese PLA General Hospital from May, 1996 to May, 2015.Based on the average FPG level of 3 years before enrollment, the subjects were divided into four groups : ＜ 5.3 mmol/L, 5.3-＜ 5.6 mmol/L, 5.6-＜ 6.1 mmol/L and 6.1-＜ 7.0 mmol/L.Glucose metabolic changes, complications and mortality were follow-up until May, 2015.Results (1)The initial 3-year average FPG levels were (4.9 ±0.4) mmol/L in the total 1 064 subjects.Among them, 126 subjects developed diabetes mellitus (DM) and 144 subjects developed impaired glucose regulation (IGR) during the follow-up visits.The proportions of IGR and diabetes increased with the FPG levels (P ＜ 0.05).The risk for developing IGR was significantly higher in subjects with FPG≥5.3 mmol/L than in those with FPG ＜ 5.3 mmol/L (RR =3.08, 95％ CI 2.02-4.81, P ＜0.01).The risk for incident DM was markedly increased in subjects with FPG ≥ 5.6 mmol/L than in those with FPG ＜5.6 mmol/L (RR =6.73, 95％ CI 3.90-11.52, P ＜0.01);(2)The risk for CVD was eight folds higher in subjects with FPG ≥5.3 mmol/L than in subjects with FPG ＜ 5.3 mmol/L (RR =8.42,95％ CI 5.11-13.82, P ＜ 0.05);(3) Survival analysis showed that the risk of death was 1.47 times higher in subjects with FPG ≥ 5.3 mmol/L than in subjects with FPG ＜ 5.3 mmol/L after years of followed-up (RR=l.47, 95％CI 1.09-1.98, P=0.0127).Conclusion The risks for IGR, CVD and mortality are higher in the elderly with FPG ≥5.3 mmol/L, which highlights the importance for the disease prevention in elder people with FPG 5.3 mmol/L or more.

OBJECTIVEThis study aimed to assess the association between emergency-room visits for respiratory tract infection (RTI) with diurnal temperature range (DTR), a weather parameter closely associated with urbanization and global climate change.

METHODSWe conducted a semiparametric time-series analysis to estimate the percentage increase in emergency-room visits for RTI associated with changes in DTR after adjustment for daily weather conditions (temperature and relative humidity) and outdoor air pollution.

RESULTSDTR was significantly associated with daily emergency-room visits for RTI. An increase of 1 °C in the current-day (L0) and in the 2-day moving average (L01) DTR corresponded to a 0.94% [95% confidence interval (CI), 0.34%-1.55%] and 2.08% (95% CI, 1.24%-2.93%) increase in emergency-room visits for RTI, respectively.

CONCLUSIONDTR was associated with increased risk of RTI. More studies are needed to understand the impact of DTR on respiratory health.

China ; Emergency Service, Hospital ; statistics & numerical data ; Humans ; Respiratory Tract Infections ; epidemiology ; Temperature

This study aimed to investigate the clinical effect of transplantation of CD133⁺ peripheral blood stem cells or umbilical cord mesenchymal stem cells via the hepatic artery in children with type II hyperammonemia and its possible action mechanism. Umbilical cord mesenchymal stem cells were obtained by collecting cord blood (100-150 mL) from healthy fetuses and separating stem cell suspension (5 mL) from the cord blood by hydroxyethyl starch sedimentation. CD133⁺ peripheral blood stem cells were obtained by mobilizing peripheral blood from the fathers of sick children using recombinant human granulocyte colony-stimulating factor for 5 days, collecting mononuclear cells (120 mL), and separating out CD133⁺ cells by sorting. With catheterization and percutaneous puncture, the obtained stem cells were slowly injected into the liver of sick children via the hepatic artery. The changes in clinical symptoms and laboratory indices such as blood ammonia, liver function, and arginine and citrulline concentrations were observed. After stem cell transplantation via the hepatic artery, the 6 children showed significantly decreased blood ammonia levels, and their blood ammonia levels slowly increased 1 to 2 weeks later, but remained below 100 μmol/L, and changes in glutamic-pyruvic transaminase levels were similar to blood ammonia. Plasma citrulline and arginine concentrations increased significantly after transplantation and the increase in citrulline level exceeded the increase in arginine level. An 8 months follow-up visit for one typical patient showed that the weight and height increased after transplantation and sleep was improved without night crying. The child could actively gaze at interesting objects instead of responding indifferently and started to say simple words. With regard to fine motor skills, the child could pinch things with the thumb and middle finger instead of displaying a lack of hand-eye coordination and progress was also made in gross motor skills. Gesell test showed that the child made progress for an average of 3.82 months in all areas. It was concluded that after stem cell transplantation, children with type II hyperammonemia have decreased blood ammonia levels, stable and improved liver function and steadily increased plasma citrulline and arginine concentrations. They display a progressive trend in such aspects as movement, language and environmental adaptability. It is hypothesized that stem cell transplantation via the hepatic artery partially or totally activates, or provides supplementary ornithine carbamoyl transferase, so that plasma citrulline and arginine concentrations increase and urea cycle disorder can be corrected to some extent.
AC133 Antigen ; Ammonia ; blood ; Antigens, CD ; analysis ; Arginine ; blood ; Citrulline ; blood ; Female ; Glycoproteins ; analysis ; Hepatic Artery ; Humans ; Hyperammonemia ; blood ; surgery ; Infant ; Male ; Peptides ; analysis ; Stem Cell Transplantation

OBJECTIVETo assess the efficiency and safety of human neural progenitor cells (hNPCs) transplantation in the treatment of pervasive developmental disorder (PDD) in children.

METHODSTwenty-two children with PDD were treated, including 13 children with Rett syndrome and 9 children with autism. They accepted hNPCs transplantation voluntarily. hNPCs derived from aborted fetal tissue were injected into the lateral ventricle of the patients under supersonic guidance. All patients were assessed according to the Autism Behavior Checklist before operation, at one and six months post operation, and one year later.

RESULTSNo delayed complications resulting from this therapy were observed. The clinical symptoms of 17 patients, including 8 patients with autism and 9 patients with Rett syndrome, improved in varying degrees. The assessment results of the Autism Behavior Checklist for children with autism showed that compared with pre-operative function, social communication scores were significantly reduced at six months after transplantation, and total scores and social communication and language scores were also significantly reduced 1 year after transplantation (P<0.05).

CONCLUSIONSThese results suggest that hNPCs transplantation is effective and safe for treatment of PPD in children. It deserves a further study.

Child ; Child Development Disorders, Pervasive ; therapy ; Child, Preschool ; Female ; Humans ; Male ; Neural Stem Cells ; transplantation ; Rett Syndrome ; therapy

BACKGROUNDResearches in ocular electromyography (EMG) and Magnetic resonance imaging (MRI) of patients with Duane retraction syndrome (DRS) suggest that there may be additional abnormalities such as paradoxical innervation between horizontal rectus muscles and vertical rectus muscles, hypoplasia of vertical rectus muscle and that oblique muscles may also contribute to the heterogeneity of the clinical manifestation of DRS. This paper reports the results of superior rectus recession for vertical deviation and A pattern in DRS Type III and discusses the pathogenesis of the disease.

METHODSSuperior and lateral rectus recession were performed in 5 cases of Huber type III DRS to treat vertical deviation and A pattern strabismus. Before operation, MRI of the brain, brainstem, cavernous sinus, and orbits were performed.

RESULTSAll subjects had unilateral limitation of both abduction and adduction, with palpebral fissure narrowing and globe retraction in adduction. Three cases had A pattern of strabismus, three cases had hypertropia. The abducens nerves (CN6) were either absent or hypoplasitic in the brainstem in all patients. Two eyes had larger oculomotor foramen. Two eyes had hypoplasia of the superior rectus and the inferior rectus. There was presumably a branch of the third cranial nerve (CN3) innervating the lateral rectus (LR) in one eye. While in another eye, two branches of CN3 sent into medial rectus were revealed. After surgery, vertical deviation in the primary position was reduced in all patients and A pattern was eliminated in 3 patients. One patient developed 10Δ consecutive esotropia postoperatively.

CONCLUSIONThe results suggest that structural abnormalities of vertical muscle and abnormal orbital innervation may be related to vertical deviation and the presence of A pattern in DRS type III. Recession of the superior rectus muscle seems to be a safe and effective treatment for vertical deviation and A pattern strabismus in DRS Type III.

Adolescent ; Child ; Duane Retraction Syndrome ; diagnosis ; Electromyography ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Young Adult