1.A bibliometric and visual analysis of the literature published in the journal of Organ Transplantation since its inception
Xi CAO ; Tao HUANG ; Qiwei YANG ; Lin YU ; Xiaowen WANG ; Wenfeng ZHU ; Haoqi CHEN ; Ning FAN ; Genshu WANG
Organ Transplantation 2026;17(1):133-142
Objective To systematically analyze the literature characteristics of Journal of Organ Transplantation since its inception. Methods Using the China National Knowledge Infrastructure (CNKI) academic journal full-text database as the data source, all articles published in the Journal of Organ Transplantation from January 2010 to August 2025 were retrieved. After excluding non-academic papers, a total of 1 568 research papers were included. R language 4.3.0, Bibliometrix package 3.2.1, and Citespace software were used to analyze the number of publications, publishing institutions, authors, keywords and other aspects. Results The number of publications in Journal of Organ Transplantation increased from an average of 82 articles per year in the early years after its inception to 113 articles per year in recent years, a growth of 37.8%. The geographical distribution of publishing institutions covers 32 provinces, cities and autonomous regions nationwide, mainly concentrated in the South China, East China and North China regions, and has now basically covered the central and western regions in recent years. The author collaboration network includes 45 authors distributed across 7 major collaboration clusters, forming a stable multi-level national research system centered on key university-affiliated hospitals. The high-frequency keywords are dominated by "liver transplantation" (425 times) and "kidney transplantation" (396 times). The theme evolution shows a clear three-stage characteristic: initially focusing on clinical technology application, deepening to immune mechanism exploration in the middle stage, and recently (since 2022) focusing on cutting-edge research areas such as xenotransplantation. Conclusions Journal of Organ Transplantation has witnessed the rapid development of China's organ transplantation cause, fully reflecting the research status and trends in China's organ transplantation field, and has provided an important platform for the future development and international cooperation in China's organ transplantation field.
2.Research on predictive models for adverse postoperative outcomes in cardiac surgery patients in western China: Integrating machine learning and SHAP interpretation
Fan LI ; Zhenfei HU ; Haiting ZHAN ; Yidan HUANG ; Xiaowen DAI
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2025;32(10):1393-1403
Objective To develop and compare the predictive performance of five machine learning models for adverse postoperative outcomes in cardiac surgery patients, and to identify key decision factors through SHapley Additive exPlanations (SHAP) interpretability analysis. Methods A retrospective collection of perioperative data (including demographic information, preoperative, intraoperative, and postoperative indicators) with 88 variables was conducted from adult cardiac surgery patients at the First Affiliated Hospital of Xinjiang Medical University in 2023. Adverse postoperative outcomes were defined as the occurrence of acute kidney injury and/or in-hospital mortality during the postoperative hospitalization period following cardiac surgery. Patients were divided into an adverse outcome group and a favorable outcome group based on the presence of adverse postoperative outcomes. After screening feature variables using the least absolute shrinkage and selection operator (LASSO) regression method, five machine learning models were constructed: eXtreme gradient boosting (XGBoost), random forest (RF), gradient boosting machine (GBM), light gradient boosting machine (LightGBM), and generalized linear model (GLM). The dataset was randomly divided into a training set and a test set at a 7 : 3 ratio using stratified sampling, with postoperative outcome as the stratification factor. Model performance was evaluated using receiver operating characteristic curves, decision curve analysis, and F1 Score. The SHAP method was applied to analyze feature contribution. Results A total of 639 patients were included, comprising 395 males and 244 females, with a median age of 62 (55, 69) years. The adverse outcome group consisted of 191 patients, while the favorable outcome group included 448 patients, resulting in an adverse postoperative outcome incidence of 29.9%. Univariate analysis showed no significant differences between the two groups for any variables (P>0.05). Using LASSO regression, 16 feature variables were selected (including cardiopulmonary bypass support time, blood glucose on postoperative day 3, creatine kinase-MB isoenzyme, systemic inflammatory response index, etc.), and five machine learning models (GLM, RF, GBM, LightGBM, XGBoost) were constructed. Evaluation results demonstrated that the XGBoost model exhibited the best predictive performance on both the training set (n=447) and test set (n=192), with area under the curve values of 0.761 [95%CI (0.719, 0.800) ] and 0.759 [95%CI (0.692, 0.818) ], respectively. It also significantly outperformed other models in positive predictive value, and balanced accuracy in the test set. Decision curve analysis further confirmed its clinical utility across various risk thresholds. SHAP analysis indicated that variables such as cardiopulmonary bypass support time, blood glucose on postoperative day 3, creatine kinase-MB isoenzyme, and inflammatory markers (SIRI, NLR, CAR) had high contributions to the prediction. Conclusion The XGBoost model effectively predicts adverse postoperative outcomes in cardiac surgery patients. Clinically, attention should be focused on cardiopulmonary bypass support time, postoperative blood glucose control, and monitoring of inflammatory levels to improve patient prognosis.
3.Research frontiers and hotspots of carbon nanomaterials in biomedical field over the past 10 years
Xiaowen DANG ; Hailiang HUANG ; Lei HUANG ; Yajie WANG
Chinese Journal of Tissue Engineering Research 2025;29(4):752-760
BACKGROUND:Research on carbon nanomaterials in the biomedical field is booming,and related scientific research results are increasing year by year.However,visualization analysis of the annual number of publications,the research status of countries,institutions,authors,and research hotspots and trends in this field is relatively scarce. OBJECTIVE:To present the research status of carbon nanomaterials in biomedical field,reveal the main research subjects,explore the research hotspots and development trends,and provide a reference for the future development of this field. METHODS:The core data set of Web of Science was used as the literature source to search the relevant researches on carbon nanomaterials in the biomedical field from 2012 to 2023.The knowledge map was generated by using Citespace software with countries,institutions,authors,keywords,and co-citations as nodes and for visualization analysis. RESULTS AND CONCLUSION:(1)A total of 2 932 papers were included in this study.In the medical field,carbon nanomaterials had a large number of papers and a fast growth rate.The United States has a large number of papers;China is an emerging force in this field,although the number of papers is the largest,but the level of research and influence need to be improved.The Chinese Academy of Sciences is the largest cooperative network institution,which mainly targets domestic institutions and lacks cooperation with well-known foreign institutions.(2)Keyword analysis displays that the green synthesis method and application of displaying carbon points have been the focus of research,followed by the new method of combining carbon nanomaterials with cancer phototherapy and immunotherapy,the key direction of future research.(3)The dynamic development trend of co-citations suggests that tissue engineering is a hot research topic of carbon nanomaterials in the field of biomedicine,mainly including the research of carbon nanomaterials for the repair and regeneration of heart and nerve tissue and as a bio-ink additive for 3D and 4D bioprinting.(4)In the future,with the development of the biomedical field in the direction of precision and treatment,researchers should speed up the creation of carbon-based systems formed by the combination of scientific and effective carbon nanomaterials with science and technology,new polymers or organic molecules,and new therapeutic methods,so as to give full play to the maximum effect of carbon nanomaterials.
4.Generalized equation estimation of the therapeutic effect of floating needle therapy combined with acupoint embedding on different stages of human knee osteoarthritis
Peiguang WANG ; Xiaowen ZHANG ; Meisi MAI ; Luqian LI ; Hao HUANG
Chinese Journal of Tissue Engineering Research 2025;29(8):1565-1571
BACKGROUND:Acupoint embedding and floating needle therapy are two methods for the treatment of knee osteoarthritis,but there are few reports on the combined treatment of the two methods. OBJECTIVE:To investigate the therapeutic effect of acupoint embedding combined with floating needle therapy on different stages of knee osteoarthritis using generalized estimating equations. METHODS:A total of 436 patients with knee osteoarthritis admitted to Dongguan Hospital of Traditional Chinese Medicine from February 2019 to February 2023 were selected as the research subjects.All patients were randomly divided into a control group with floating needle therapy(n=218)and an observation group with acupoint embedding method combined with floating needle therapy(n=218).Staging was performed according to the K-L staging method.In the control group,there were 57 cases in stage Ⅰ,62 in stage Ⅱ,49 in phase Ⅲ,and 50 in stage Ⅳ,while in the observation group,there were 48 cases in stage Ⅰ,66 in stage Ⅱ,63 in phase Ⅲ,and 41 in stage Ⅳ.The levels of indexes and clinical efficacy were compared between groups before and after treatment.Generalized estimating equation model was used to analyze the influencing factors of clinical efficacy and the interaction effect of different time points,different methods and different stages on therapeutic efficacy. RESULTS AND CONCLUSION:There was no significant difference in baseline data between the observation group and the control group,as well as between the patients of different stages(P>0.05).After treatment,the cure rate of stage Ⅰ patients was the highest after treatment,and the total improvement rate in the observation group was significantly higher than that in the control group.There were significant differences in the cure rate among different stages in each group(P<0.05).After treatment,all indicators in the two groups were significantly decreased.In the control group,there were significant differences in various indicators of patients at different stages after 4 weeks of treatment(P<0.05).In the observation group,after 2 weeks of treatment,there were significant differences in various indicators of patients at different stages(P<0.05),and all the indexes in the observation were lower than those in the control group after 4 weeks of treatment(P<0.05)and the therapeutic effect in the observation group was better than that in the control group.Generalized estimating equation model analysis showed that trauma history,interleukin-6 level,treatment method,treatment time and K-L stage all significantly affected the clinical efficacy in patients.In the interaction effect analysis,after 2 weeks of treatment,there was a significant difference in the visual analogue scale score between the two groups in stages Ⅲ and Ⅳ(P<0.05).After 4 weeks of treatment,there was a significant difference in the visual analogue scale score between the two groups in stages Ⅱ,Ⅲ,and Ⅳ(P<0.05).To conclude,acupoint embedding combined with floating needle therapy is superior to floating needle therapy alone in the treatment of different stages of knee osteoarthritis.Trauma history,interleukin-6 level,treatment method,treatment time and K-L stage significantly influence the therapeutic effect.
5.Dynamic immunological characteristics in acute rejection model of cervical heterotopic heart transplantation in mice
Xi CAO ; Tao HUANG ; Jiwei YANG ; Xiaowen WANG ; Wenfeng ZHU ; Haoqi CHEN ; Ning FAN ; Genshu WANG
Organ Transplantation 2025;16(2):256-263
Objective To establish an acute rejection model of cervical heart transplantation in mice and evaluate the survival and dynamic rejection process post-transplantation. Methods Mice were randomly divided into sham operation group (n=10), syngeneic transplantation group (n=21), and allogeneic transplantation group (n=65). Sham operation, syngeneic cervical heart transplantation, and allogeneic cervical heart transplantation were performed respectively. The survival of recipient mice and grafts, histopathological changes of graft tissues, subpopulations of splenic lymphocytes, and expression of inflammatory factors in serum and grafts were observed. Results The survival rate and graft survival rate of the sham operation group and syngeneic transplantation group were 100% at 7 days after surgery. In the allogeneic transplantation group, 5 cases failed and died on the first day after surgery. The survival rate at 7 days after surgery was 86%, and all surviving mice had grafts that stopped beating at 7 days after surgery. The allogeneic transplantation group showed significant rejection at 7 days after surgery, accompanied by tissue damage and CD8+ T cell infiltration. The proportion of CD8+ T cells in the spleen continued to rise post-operation, while the proportion of CD4+ T cells showed a downward trend. The expression of interferon-γ in serum and grafts peaked at 5 days after surgery, while the expression of tumor necrosis factor-α showed no statistical significance. Conclusions Acute rejection following heart transplantation in mice intensifies between 5 to 7 days after surgery, which may be a critical time window for immunological intervention.
6.Feasibility of Radiomics Combined with Brisque for Automated Assessment of Hepatic Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid Dynamic Enhanced Arterial Phase Image Quality
Tingting LI ; Xiaowen WANG ; Ying HUANG ; Lan ZHANG
Chinese Journal of Medical Imaging 2025;33(6):651-656
Purpose To explore the feasibility and validity of radiomics combined with blind/referenceless image spatial quality evaluator(Brisque)for automated assessment of arterial-phase image quality in hepatic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)dynamic enhanced MRI examinations.Materials and Methods A total of 326 arterial phase images from January 2020 to March 2024 in the First Affiliated Hospital of Henan University of Chinese Medicine for liver Gd-EOB-DTPA dynamic enhancement MRI examination were retrospectively collected.A 4-level(1-4 points)Likert scale was used for subjective image quality scoring,and then binary classification was used to divide the images into clinically acceptable group(166 images with a score of 2-4)and clinically unacceptable group(160 images with a score of 1).All images were randomly divided into a training set(227 images)and a test set(99 images)in a 7∶3 ratio.Brisque images were created based on arterial-phase images,and subsequently Brisque image features,image histologic features of the original arterial-phase images and combined features of the two were extracted.The extracted data were reduced in dimension and the optimal features of radiomics were selected.Based on the Logistic regression algorithm,radiomics models,Brisque models and combined models of the two were constructed.The receiver operating characteristic curve was drawn for each subject,and the area under the curve(AUC),threshold,sensitivity,specificity,accuracy,negative predictive value and positive predictive value were calculated to analyze the diagnostic performance of each model,and the net benefit of the models was evaluated by decision curve analysis.Results The AUC values of the radiomics model,Brisque model and combined model in the training set were 0.942(95%CI 0.914-0.969),0.722(95%CI 0.655-0.788)and 0.967(95%CI 0.947-0.987),respectively.In the test set,the AUC values were 0.904(95%CI 0.848-0.960),0.684(95%CI 0.579-0.789)and 0.920(95%CI 0.866-0.972),respectively.There was statistically significant difference between two of the three models in the training set(Z=6.493,3.397,7.427;all P<0.05);in the test set,there was statistically significant difference between the combined model and the Brisque model,and between the radiomics model and the Brisque model(Z=4.137,3.740,both P<0.05),but no statistically significant difference between the combined model and the radiomics model(P>0.05).The diagnostic performance was higher in the combined model in both the training set and the test set.The decision curve analysis curve suggested that the net benefit of the combined model was greater than that of the other two models.Conclusion Radiomics combined with Brisque can be applied in the assessment of the quality of arterial-phase images in Gd-EOB-DTPA dynamic-enhanced MRI examinations of the liver to automatically detect clinically unacceptable arterial-phase images of the liver with high diagnostic efficacy,which contributes to the improvement of the quality of the images at the time of acquisition,leading to a reduction in the number of duplicate scans and an increase in the accuracy of the diagnosis.
7.Effects of exercise load on cardiac function in different bodily positions evaluated with three-dimensional speckle tracking technology
Chongfa ZHONG ; Feng ZANG ; Xiaowen ZUO ; Yue WANG ; Yuqing GAI ; Zemin HUANG ; Bin WU ; Guangdan YU ; Chong XU
Chinese Journal of Aerospace Medicine 2025;36(1):12-17
Objective:To investigate the effects of 10° head up tilt bed rest (HUT) on human cardiac function via 3D speckle tracking echocardiography (3D-STE), and to study the difference in cardiac function under the submaximal exercise load between the horizontal position and 10° HUBR.Methods:Thirty young healthy volunteers were recruited as the subjects, who were randomly divided into an 10° HUT exercise group and horizontal exercise group with 15 subjects in each. Subjects in both groups were asked to ride the bicycle ergometer in the 10° HUBR position and supine position respectively. The load started with 50 W and was increased by 25 W every 3 min until it reached the maximum of 125 W. Before the exercise (resting state), 1 min after the load was increased each time, and 3 min after exercise (recovery period), the following indices were collected: ①basic cardiac function indices: heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), ②conventional cardiac ultrasound indices: left ventricular ejection fraction (LVEF), stroke volume (SV) and cardiac output (CO), ③left ventricular strain indices: global longitudinal strain (GLS), global circumferential strain (GCS), and global area strain (GAS) measured by 3D-SET. The changes of these indices in the 2 groups of subjects under different exercise loads were observed.Results:The differences in the major effect of the basic heart indices (HR, SBP and DBP), conventional cardiac ultrasound indices (LVEF, SV and CO) and left ventricular strain indices (GLS, GCS and GAS) in response to the exercise load were statistically significant ( F=194.90, 113.66, 17.19, P=0.017, 0.018, 0.001). With the increase of the exercise load, the basic heart indices and conventional cardiac ultrasound indices kept rising, the left ventricular strain indices reached the minimum under a moderate exercise load (75 W), HR, SBP and CO were higher than those of the resting state ( P<0.05 or 0.01). Both LVEF under exercise loads of 75, 100, 125 W and during recovery, and SV under exercise loads of 100, 125 W and during recovery were significantly higher than those of the resting state ( P<0.05 or 0.01), while GLS and GCS under exercise loads of 50, 75, 125 W ( P<0.05 or 0.01), and GAS under exercise loads of 50, 75 W ( P<0.01) were significantly lower. There were statistically significant differences not only in GCS across the groups ( F=4.60, P=0.026) but also in DBP due to the interactions between the grouping and exercise loads ( F=3.13, P=0.031). DBP was higher than that of the resting state when the exercise load was 125 W in both groups. Conclusions:During submaximal exercise, myocardial contractility shows sustained enhancement with the increase of the exercise load. The results of GLS, GCS and GAS indicate that myocardial strain reaches its lowest value under a moderate exercise load, suggesting that moderate exercise can be used to evaluate cardiac function via 3D-SET. Under a simulated lunar gravity of 10° HUT, there is less deformation in the short axis direction of the myocardium, indicating that GCS can be used as a sensitive indicator to detect changes in cardiac function under different gravities.
8.A prediction model for in-hospital mortality in elderly patients undergoing unsynchronous cardioversion in ICU
Dan HUANG ; Manli YUAN ; Xiaowen ZUO ; Yongjie XU ; Ye TAO ; Sheng MA ; Zhao YIN
Chinese Journal of Geriatric Heart Brain and Vessel Diseases 2025;27(9):1193-1198
Objective To construct a prediction model for in-hospital mortality in the elderly(≥65 years)patients undergoing unsynchronous cardioversion in ICU and to evaluate its effectiveness.Methods A retrospective study was conducted on 276 elderly eligible patients in the ICU of the Ninth and the First Medical Centers of Chinese PLA General Hospital between June 2022 and August 2024.According to their clinical outcomes,they were divided into a non-in-hospital dead group(111 cases)and an in-hospital dead group(165 cases).Clinical data were collected,and pre-dictive factors for in-hospital mortality were screened.And then a nomogram prediction model was developed based on the obtained predictive factors,which was evaluated with ROC curve and deci-sion curve analyses.Results When compared to the non-in-hospital dead group,the in-hospital dead group had significantly higher heart rate,ratio of hemodialysis,and levels of alanine amin-otransferase,aspartate aminotransferase,lactate dehydrogenase,alkaline phosphatase,serum cre-atinine,blood glucose,lactate,low base excess,sequential organ failure assessment(SOFA)score,model for end-stage liver disease score,and larger proportions of ventricular fibrillation/flutter and structural heart disease induced by pulseless ventricular tachycardia,and had significantly lower Glasgow Coma Scale(GCS)(P<0.05).Multivariate logistic regression analysis identified body temperature>37℃(OR=0.426,95%CI:0.198-0.915,P=0.029),chronic obstructive pulmonary disease(OR=2.333,95%CI:1.217-4.473,P=0.011),GCS score(OR=0.622,95%CI:0.410-0.944,P=0.026),hemoglobin(OR=0.817,95%CI:0.715-0.934,P=0.003),lactate(OR=1.365,95%CI:1.174-1.587,P=0.000),heart rate>100 bpm(OR=2.757,95%CI:1.397-5.441,P=0.003),and SOFA score(OR=1.112,95%CI:1.032-1.198,P=0.005)as pre-dictors of in-hospital mortality.ROC curve analysis showed an AUC value of above indicators combined together in the prediction was 0.797,with a sensitivity of 76.97%and a specificity of 65.77%.Calibration curve analysis demonstrated good consistency between predicted and observed outcomes.Decision curve analysis indicated favorable clinical utility of the model.Conclusion This study identifies independent risk factors for in-hospital mortality among elderly patients in the ICU who underwent asynchronous cardioversion.Based on these factors,a nomo-gram model is established,demonstrating good discrimination,calibration,and model fit,with high clinical applicability.
9.A single-center observational study of eculizumab in the treatment of children with atypical hemolytic-uremic syndrome
Panli LIAO ; Gaohong ZHU ; Huihui YANG ; Lin HUANG ; Daojing WANG ; Jia WANG ; Heng LIU ; Qianqian JIANG ; Xiaowen WANG
Chinese Journal of Nephrology 2025;41(7):516-521
Objective:To observe the efficacy of eculizumab in children with atypical hemolytic uremic syndrome.Methods:It was a single-center observational study. The clinical data of children diagnosed with atypical hemolytic uremic syndrome and treated with eculizumab in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2023 to May 2024 were retrospectively collected. Eculizumab was used at the conventional dose based on the children 's weight. Event-free survival (no death or end-stage renal disease) rate, complete remission rate and recurrence rate of thrombotic microangiopathy in children with atypical hemolytic uremic syndrome after eculizumab treatment were analyzed. The complete remission time of estimated glomerular filtration rate, hemoglobin, platelet, lactic dehydrogenase, urine routine and the adverse reactions during the treatment were observed. Whole exome sequencing was used to conduct genetic testing based on blood samples of the children and their parents.Results:There were 4 children enrolled in the study. Four children were all Han Chinese, including 3 males and 1 female. The median age of onset was 8 years (ranging from 7 to 10 years). Two patients had complement gene abnormalities, both of which were homozygous deletions of complement factor H-related 1 and complement factor H-related 3. All the patients were free of plasma exchange or perfusion after treatment with eculizumab, and the 6-month event-free survival rate and thrombotic microangiopathy complete remission rate were both 4/4. The complete remission time was 19 (14-28) days. The time for the complete recovery of platelets, lactate dehydrogenase, estimated glomerular filtration rate and hemoglobin in 4 children was 4 (1-5), 19 (14-28), 10 (5-14) and 29 (20-42) days, respectively. Except for 1 patient whose urine routine fluctuated between negative and weakly positive expression, the other 3 patients had normal urine routine. All the patients discontinued eculizumab. Two patients without gene mutations discontinued eculizumab after 7 doses, and there was no recurrence during the 1-year follow-up after drug withdrawal. Two patients with genetic abnormalities discontinued eculizumab after 26 weeks of treatment, and no recurrence was found during the 3-month follow-up after drug withdrawal. One patient developed rash approximately 7 days after receiving the third dose of eculizumab. The rash was relieved after anti-allergic treatment, and there was no recurrence after the continued use of eculizumab.Conclusion:Eculizumab is effective and safe in the treatment of children with atypical hemolytic uremic syndrome. Discontinuation of eculizumab can be considered in patients without gene mutations when their condition is stable, but close monitoring and follow-up are needed after drug withdrawal.
10.Risk factors for mortality in neonatal necrotizing enterocolitis: analysis of 118 cases
Yueju CAI ; Yuying LIN ; Dabin HUANG ; Xiaowen CHEN ; Yongjiang JIANG ; Wei ZHOU
Chinese Journal of Perinatal Medicine 2025;28(2):142-149
Objective:To investigate the risk factors for mortality in neonates with necrotizing enterocolitis (NEC).Methods:This retrospective cohort study included patients diagnosed with NEC at stage Ⅱ-Ⅲ (Bell's criteria) and admitted to the Neonatology Department of Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University from January 2017 to December 2022. According to the outcomes, these patients were divided into the mortality and survival groups. Perinatal conditions, clinical manifestations, disease status during hospitalization, and blood routine parameters at different time points after birth were compared between the two groups to analyze the risk factors for mortality of NEC. Statistical analysis was performed using independent-sample t-test, Mann-Whitney U test, Chi-square test (or Fisher's exact test), and multivariate logistic regression analysis. Results:(1) A total of 118 NEC cases were included, with 100 in the survival group and 18 in the mortality group. (2) The gestational age and birth weight were significantly lower in the mortality group than in the survival group [(28.9±4.2) weeks vs. (33.7±3.9) weeks, t=4.78; 940 g (685-1 275 g) vs. 1 830 g (1 352-2 368 g), Z=4.18; both P<0.05]. The incidence of neonatal asphyxia was higher in the mortality group [9/18 vs. 18% (18/100), χ2=7.13, P<0.05]. (3) Compared with the survival group, the mortality group had higher proportions of patients who were at NEC stage Ⅲ, accepted surgery, were treated with vasoactive drugs, had undergone invasive mechanical ventilation, or had metabolic acidosis, hyperlactatemia, shock, or hematochezia [17/18 vs. 24% (24/100), χ2=33.39; 17/18 vs. 31% (31/100), χ2=22.88; 16/18 vs. 22% (22/100), χ2=31.26; 16/18 vs. 39% (39/100), χ2=15.26; 18/18 vs. 28% (28/100), χ2=30.29; 16/18 vs. 20% (20/100), χ2=34.15; 17/18 vs. 21% (21/100), χ2=37.69; 9/18 vs. 82% (82/100), χ2=7.13; all P<0.05]. (4) The proportions of patients who developed late-onset sepsis, hemodynamically- significant patent ductus arteriosus, respiratory distress syndrome, or pulmonary hemorrhage were significantly higher in the mortality group than in the survival group [15/18 vs. 33% (33/100), χ2=16.01; 9/18 vs. 21% (21/100), χ2=5.32; 15/18 vs. 39% (39/100), χ2=12.08; 7/18 vs. 7% (7/100), χ2=11.94; all P<0.05]. (5) Within 24 h of birth, the levels of red blood cells and platelets were lower in the mortality group than in the survival group [4.1×1012/L (3.8×10 12/L-4.6×10 12/L) vs. 4.6×10 12/L (4.0×10 12/L-4.9×10 12/L), Z=2.04; (199.9±68.6)×10 9/L vs. (239.8±72.6)×10 9/L, t=2.16; both P<0.05]; at 6-8 d after birth, the levels of red blood cells, hemoglobin (Hb) and hematocrit (HCT) were lower in the mortality group than in the survival group [(3.2±0.5)×10 12/L vs. (3.9±0.8)×10 12/L, t=3.30; (111.2±19.2) vs. (138.1±28.3) g/L, t=3.51; (33.0±5.4)% vs. (40.9±8.1)%, t=3.61; all P<0.05]; at the diagnosis of NEC, red blood cell count, Hb level, HCT, and platelet count were lower in the mortality group than in the survival group [(3.3±1.0)×10 12/L vs. (3.8±0.8)×10 12/L, t=2.47; (102.8±28.8) vs. (124.4±26.3) g/L, t=3.59; 31.0% (25.9%-38.4%) vs. 37.2% (31.5%-43.7%), Z=2.62; 87.0×10 9/L (50.2×10 9/L-157.0×10 9/L) vs. 228.0×10 9/L (130.0×10 9/L-414.7×10 9/L), Z=3.78; all P<0.05], while mean platelet volume (MPV), platelet distribution width, and the differences in hemoglobin (ΔHb) and hematocrit (ΔHCT) between the first 24 h after birth and 6-8 d after birth were significantly higher in the mortality group than in the survival group [13.1 fl (11.4-13.6 fl) vs. 11.6 fl (10.7-12.4 fl), Z=3.26; 19.6% (13.9%-25.2%) vs. 14.8% (12.0%-18.6%), Z=2.76; 35.5 g/L (28.3-57.3 g/L) vs. 27.0 g/L (8.0-42.5 g/L), Z=2.20;11.5% (9.4%-16.3%) vs. 6.3% (2.2%-11.2%), Z=2.85; all P<0.05]. (6) Late-onset sepsis ( OR=5.568, 95% CI: 1.201-25.816), hyperlactatemia ( OR=6.702, 95% CI: 1.193-37.651), shock ( OR=10.616, 95% CI: 1.157-97.406) and MPV elevation at the diagnosis of NEC ( OR=2.769, 95% CI: 1.468-5.223) were independent risk factors, while gestational age ( OR=0.836, 95% CI: 0.708-0.986), and HCT at 6-8 d after birth ( OR=0.848, 95% CI: 0.759-0.947) were protecting fctors for death in NEC. Conclusions:Preterm infants with smaller gestational age are more prone to mortality of NEC. Early identification and management of late-onset sepsis, shock, and hyperlactatemia may reduce the risk of mortality in NEC.

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