Objective To summarise the clinical data of neonatal early onset sepsis (EOS) and investigate the correlation factors, clinical manifestation, diagnosis, therapy and prognosis of EOS. Methods Data of 32 neonatal EOS patients admitted into the neonatal intensive care unit, Peking Union Medical College Hospital from January 2000 to June 2009 were collected and retrospectively analyzed. Results Among 32 EOS infants, there were 23 preterm infants (71.9%), nine term infants (28.1%); 21 low birth weight infants (65.6%), six very low birth weight infants (18.8%) and one macrosomia (3.1%). Among 32 mothers, 27 (84.4%) were accompanied with various kinds of complications during perinatal period, such as 15 perinatal infection (46.9%), six preeclampsia (18.8%), five gestational diabetes mellitus (15.6%) and one hypothyroidism (3.1%). EOS infants had various clinical manifestations, including 25 low response (78.1%), 20 respiration or temperature abnormity (62.5%), 18 pallor and clammy skin (56.3%), 18 feeding intolerance (56.3%), 18 fever (56.3%), 15 metabolic acidosis (46.9%), 8 infectious shock (25.0%), 20(62.5%) high white blood cell count (>25×109/L), 22 (68.8%) low blood platelets (<100×109/L) and 28 (87.5%) high C-reaction protein (>8 mg/L). Blood culture of 24 infants were positive (75.0%), among which nine infections were caused by gram-positive bacteria (9/24, 37.5%), including Listeria monocytogenes, group B Streptococcus, Staphylococcus, et al; 15 infections were caused by gram-negative bacteria (15/24, 62.5%), including Klebsiella Pneumoniae, Enterobacteria, Bacillus Smaragdinus, et al. Antibiotics were used in all infants when EOS was supposed to be or infectious symptoms were presented, and were adjusted under the results of culture. Twenty-two infants (68.8%) were cured, eight(25.0%) were given up from the therapy, two(6.3%) died. Conclusions The neonatal EOS correlates to various kinds of perinatal factors, its clinical manifestations are complicated and usually involves many systems. Multiple factors in perinatal period, clinical manifestation and laboratory examinations should be considered to make early diagnosis, assist management to improve the prognosis.

Objective To discuss the treatment effect of locking-proximal-humerus-plate (LPHP) for three- or four-part proximal humeral fractures. Methods A retrospective study was done on 13 cases of proximal humeral fractures treated with LPHP from July 2003 to January 2005. There were six males and seven females, with age of 24-73 years (mean 49.8 years). According to Neer classification, five cases were with three-part fractures and eight with four-part fractures including six cases with osteoporosis. Reduction and fixation was done via deltopectoral-groove approach, without cutting the capsule or peeling the soft tissues of the greater and lesser tuberosity. Of all, three cases with bone defects was treated with allografts. Shoulder exercise could be performed passively three days after operation. One week after operation, passive and active shoulder exercise was done, which was gradually intensified two weeks after operation. Results A follow up for 3-20 months (average 11 months) on 12 cases showed that all fractures were healed. According the Neer shoulder score, the results was excellent in six cases, good in four and fair in two, with excellence rate of 83.3%. Conclusions The screw of LPHP can lock the plate so that the plate can firmly fixate the fractures without tightly contacting the bone, as simultaneously reaches fracture healing and function exercise and enhances the treatment effect. LPHP is a specially suitable procedure for osteoporosis and three-or four-part proximal humeral fractures.

Objective To summarize and analyze the impact factors on enteral feeding in very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI). Methods A retrospective study was carried out in VLBWI and ELBWI who had achieved full enteral feeding prior to discharge. The impact factors correlated to the time of achieving full enteral feeding were analyzed. If the data underwent bi-variable normal distribution, they were analyzed with Pearson correlation test; otherwise they would be analyzed with Spearman correlation test. T test was used for single factor analysis and multiple linear regression analysis was carried out to determine the significant risk factors associated with the time of achieving full enteral feeding. Results One hundred and forty-seven infants with mean gestational age of (31.0±2.0) weeks, mean birth weight of (1246±185) g and mean time of achieving full enteral feeding of (24. 4± 10. 5) days were admitted. With the single factor analysis, it was found that birth weight (r=- 0. 477, P = 0. 000), gestational age (r = - 0. 405, P= 0. 000), mechanical ventilation duration (r= 0. 393, P = 0. 000), the time began to enteral feeding (r = 0. 318, P = 0. 000), initial milk volume (r = - 0. 263, P = 0. 001 ), the milk volume on the third day (r= -0. 412, P=0. 000) and the seventh day (r= -0. 592, P=0. 000),neonatal respiratory distress syndrome (t = 3. 368, P = 0. 001), umbilical catheterization (t = 3. 571,P=0. 000), abnormal blood glucose level (t=3. 285, P=0. 001), aminophylline using (t=4. 341,P=0. 000), phototherapy (t=3. 054, P=0. 003) and sepsis (t=3. 244, P=0. 001) were correlated to the time of achieving full enteral feeding. Multiple linear regression showed that the birth weight (t=4. 175, P= 0. 000), the time began to enteral feeding (t= 2. 851, P = 0. 005), aminophylline using (t=2. 231, P=0. 027), sepsis (t=3. 895, P=0. 000), phototherapy (t=2. 852, P=0. 005)and the milk volume on the seventh day (t= 7. 332, P=0. 000) were significantly correlated with the time of achieving full enteral feeding. Conclusions The enteral feeding of VLBWI and ELBWI was not only influenced by maturity of gastrointestinal tract, but also by other parenteral correlation factors. Multiple factors associated with all around clinical conditions should be considered when providing enteral feeding for VLBWI and ELBWI.

Objective To discuss the clinical features and possible mechanisms of congenrtal leuleemia spontaneous remission. Methods By means of literature review, 17 cases with spontaneous remission of congenital leukemia were retrospectively analyzed. Results Among the 17 patients, 8 were persistent remission(47%), 9 had late relapses(53%). Neither initial white cell count nor bone marrow involvement was associated with late relapses. 5 cases(29%) had abnormal karyotype and gene rearrangment,11q23 translocation indicated poor prognosis. Conclusions Conservative treatment can be given unless there was evidence of progressive leukemia. Because of occasional late relapses, long term follow-up was recommended. The detection of karyotype and gene rearrangment was a powerful prognostic tool available.

Objective To investigate the blood lead level and its related factors in children in Chongqing and to provide evidence for the prevention and treatment of lead contamination. Methods In June 2001, the blood lead levels in 173 children(aged 2～7 2 years old) selected from 2 kindergartens representing the children in urban district and suburb were detected. At the same time, the related factors were investigated by using questionnaires. Results The highest, the lowest and the mean blood lead levels were 270 ?g/L, 18 ?g/L and 77 73 ?g/L, respectively. The blood lead level of 23 70% children investigated surpassed 100 ?g/L(the international diagnostic criterion of lead poisoning in children). Significant regional difference in blood lead level was found. The mean blood lead levels in children in Yuzhong District and Dadukou District were 111 23 ?g/L and 57 57 ?g/L, respectively. The percentages of children in the two districts with blood lead levels higher than 100 ?g/L were 52 31% and 6 48%, respectively. Blood lead level was closely correlated with the dwelling condition, the dwelling location where factories were nearby or the number of factories was large, health habits, the frequency of eating canned food and popcorn, and culture levels of the mothers. Conclusion Blood lead level of children in the urban distict is significantly higher than that in the suburb, to which more attention should be paid.

Objective To develop a HPLC method for the determination of oxymatrine in Oxymatrin Injection.Methods A RP-HPLC method with Lichrospher 5 ODS C18 column(4.6 mm? 250 mm,5 ? m) was used,and the mobile phase was the mixture of acetonnitrile-pH2.0 sulphate buffer solution(7∶93) at the f low rate of 1.0mL/min.The column temperature was 30 ℃,the UV detection wave length was 220 nm and the injection volume was 20 ? L.Results The calibra tion curve was linear(r=1.0000) in the range of 3.63～ 116.04 ? g/mL for oxyma trine.The mean recovery was 100.1 %(RSD=0.86 %,n=6).Conclusion Thi s method is effective and can be used for the determination of oxymatrine in Oxymatrine Injection.

Objective To explore the affinify of combination of Helicobacter pylori (Hp) and its L-form with surfactant protein D(SP-D),and to find function of SP-D in Hp infection and immunity. Methods SP-D was extracted from the lung of rats by Tris-HCl-EDTA and maltose-agarose affinity column. The combination of Hp and SP-D was detected by slide and tube agglutination tests,and the agglutination inhibition with SP-D immune serum was carried out. The L-form of Hp was induced by Ceftriaxon sodrum and identified by PCR and sequencing of the 16S rDNA fragment.The combination of SP-D and the L-form was tested by slide agglutination test. Results Agglutination of Hp NCTC11637 and SP-D was observed on slide,but NCTC11639,SS1 and the L-form failed to agglutinate. Agglutination was found 45 minutes after reaction and was inhibited by SP-D immune sera. Conclusion The ability of combination with SP-D was different between strains of Hp.The combination could be weakened or vanished when Hp lost the cell wall.

Objective To evaluate the nutritional status of extremely low birth weight (ELBW) infants and the effects of nutritional support strategy alterations on their growth during hospitalization.Method From 2005 to 2014,clinical data of ELBW infants admitted to the neonatal intensive care unit (NICU) in our hospital were retrospectively analyzed.The clinical data included their general status,enteral and parental nutritional support strategy and complications during hospitalization The patients were assigned into pre5 group and late5 group.Those who survived and discharged from 2005 to 2009 were the pre5 group,and those who survived and discharged fromn 2010 to 2014 were the late5 group.The independent t test and chi square test were used for statistical analysis.Result A total of 58 ELBW infants were enrolled in the study,including 18 patients in the pre5 group and 40 in the late5 group.No statistically significant differences existed between the two groups on gestational age,birth weight,Z score (weight for length and gender),birth length,head circumference and main complications during hospitalization (P ＞0.05).Pre5 group had higher incidence of small for gestational age (SGA) than late5 group (16/18 vs.25/40,P =0.037),while the EUGR ratio at discharge (14/18 vs.21/40,P =0.061) was similar.When compared with pre5 group,late5 group had larger amount of initial enteral feeding volume [4.4 ml/(kg · d) vs.2.4 ml/(kg · d),P =0.014] and feeding volume at the end of the first week [(19.8 ± 16.0) ml/(kg · d) vs.(12.2 ±9.5) ml/(kg · d),P =0.036].Similarly,the starting dose of amino acids in parenteral nutrition [2.0g/(kg· d) vs.1.0 g/(kg· d),P＜0.001],maximum dose of amino acids [4.0g/(kg.d) vs.3.5 g/(kg · d),P ＜ 0.001],total calories at the end of the first week [(82.6 ± 12.6) kcal/(kg · d) vs.(71.1±15.2) kcal/(kg· d),P=0.004] and the second week [(103.7 ±19.8) kcal/(kg· d) vs.(92.3 ± 17.9) kcal/(kg · d),P =0.041],the weight gain velocity from birth to discharge [(18.7 ± 2.9) g/(kg.d) vs.(16.9±2.8) g/(kg· d),P=0.031] and change of Z scores (AZ) [-0.6 (-1.0,-0.4) vs.-1.2 (-1.6,-0.8),P =0.004] showed significantl differences between the two groups,with better outcomes in late5 group.However,the duration of parenteral nutrition,the total amount of amino acids,the time reaching total enteral feeding,the length of hospital stay were similar between the two groups.Ten cases(61.1％)of infants in pre5 group were breastfed,and four of them used human milk fortifier (HMF) (fortified rate was 22％).32 cases (80％) in late5 group were breastfed and 23 cases used HMF (fortified rate was 57.5％).The time to initiate HMF in the late5 group was at (30.2 ± 13.2) days,and human milk amount was (89.9 ± 34.5) ml/kg,fortified duration was (32.8 ± 15.7) days.Conclusion The enteral feeding strategy were more vigorous in the last 5 years than before,the initial feeding volume,the increasing rate,the initial dosage of amino acid,and maximum dosage of amino acid had been increased.Human milk and HMF of preterm infants were preferred.The vigorous nutritional support strategy were effective for the weight gain of ELBW infants without obvious side effects during hospitalization.

Objective To summarize the clinical features and possible impacts of Goodpasture's syndrome in pregnancy on the pulmonary and kidney of the newborn and the mothers. Methods One patient diagnosed Goodpasture's syndrome in pregnancy hospitalized in Peking Union Medical College Hospital on August 23 in 2011 delivered a neonate with bullae of lung. And literatures including 8 cases of pregnancy complicated by Goodpasture's syndrome worldwide through Medline were reviewed. Results (1) Case report:one 31-year-old women presented with acute renal failure at 30+6 weeks of gestation and delivered a male infant with birth weight 1 900 g by caesarean section at 31+1 weeks of gestation. Diagnosis was confirmed as Goodpasture's syndrome with anti-glomerular basement membrane(GBM) antibodies in serum and renal biopsy after delivery. Then she was treated with methylprednisolone, cyclophosphamide, plasmapheresis and dialysis. The neonate showed the lung bullae in the right middle lobe and bilateral intraventricular hemorrhage but renal function was transient normal with anti-GBM as 113.1 EU/ml. The baby was treated by glucocorticoid for two months and clinical symptoms were improved. Anti-GBM antibodies and chest CT showed normal. After been followed up for two years, the baby was normal. (2) Literatures review:the main manifestations of Goodpasture's syndrome in pregnancy were malignant hypertension and renal failure but respiratory symptoms were not obvious. Treated with plasmapheresis, hematodialysis and glucocorticoid maybe have good effects. Most cases had premature delivery. Neonatal anti-GBM antibodies coming from mothers could result to cerebral, renal and pulmonary injury which could be treated by glucocorticoid. Conclusions The Clinical features of pregnancy complicating the Goodpasture's syndrome are malignant hypertension and renal failure. Diagnosis was depended on positive anti-GBM antibodies and renal pathological changes and treatment were depended on plasmapheresis, hematodialysis and glucocorticoid. Neonatal cerebral, renal and pulmonary injury resulting from anti-GBM antibodies coming from mothers should be followed up, and glucocorticoid should be taken if necessary.

Objective To evaluate the indications and clinical efficacy of the different surgical methods for lumbosacral tuberculosis.Methods 112 patients suffering from lumbosacral tuberculosis from January 1998 to October 2011 were reviewed retrospectively.Based on American Spinal Injury Association (ASIA) grading system,31 case was classified as grade C,32 as grade D and 49 as grade E.The affected locations were L5,S1 in 66 cases,L4-S1 in 32,and L5-S2in 14 cases.41 cases (posterior group) underwent posterior pedicle screw instrumentation,debridement and allograft; and 38 cases (anterior group) underwent one-stage anterolateral debridement plus allograft and internal fixation.33 (posterior-anterior group) cases experienced posterior pedicle screw instrumentation and anterior debridement and allograft.All cases underwent routine support and anti-tuberculosis treatment before and after operation.The change of erythrocyte sedimentation rate (ESR),signs of tuberculosis activity,graft fusion,neurological recovery and correction of deformity were evaluated in follow-up and compared among three groups.Results The average operating time in posterior,anterior and posterior-anterior group was (150±22) m in,(140± 18) min,(180± 1 8) min respectively.ESR and C-reactive protein (CRP) were recovered to normal 3 months post surgery.The quality of life total score of lumbosacral tuberculosis patients was very low (55.54 ± 9.23).After surgery and drug treatment,the total score and each dimension scores of the SF-36 were significantly improved.Postoperative ASIA classification and 1umbosacral angle were significantly improved.Tuberculosis recurrence occurred in three cases,fixation loosening in two cases,fixation fracture in one case,and all above cases were cured after revision surgery.The others all were cured and bone graft fusion was determined.Conclusion The quality of life of lumbosacral tuberculosis patients were impacted seriously,and which could be significantly improved with surgical intervention.According to the patient MRI,CT characteristics,surgical approach selection was based on lesion location.Effective internal fixation was based on the extent of damage in bone structure and anatomical characteristics.Following above principles,satisfactory clinical results could be achieved.