Objective:To investigate the association between small vulnerable newborn (SVN) phenotypes and the risk of neurodevelopmental delay at the age of 1 year.Methods:A prospective cohort study was conducted. A total of 25 860 singleton infants from "The Born in Guangzhou Cohort Study" who completed the Gesell developmental scale assessment at 1 year of age between January 2013 and June 2025 were included. Maternal sociodemographic characteristics, and other information were collected using a self-administered questionnaire, and maternal pregnancy-related information and neonatal birth data were extracted from medical records. Global developmental delay (GDD) was defined as a developmental quotient below 86 in ≥3 domains of the Gesell developmental scale, which assesses the adaptive, gross motor, fine motor, language, and personal-social domains. The random forest algorithm was employed for missing data imputation. Based on prematurity, small for gestational age (SGA), and low birth weight (LBW), newborns were categorized into 6 phenotypes: preterm-SGA-LBW, preterm-appropriate for gestational age (AGA)-LBW, preterm-AGA-nonLBW, term-SGA-LBW, term-LBW-only or term-SGA-only, and term-AGA-nonLBW phenotype. Among these, the first 5 were classified as SVN phenotypes, and the last one served as the reference group. Inter-group comparisons were performed using analysis of variance (ANOVA), χ2 tests, or Kruskal-Wallis test, as appropriate.?? Multivariable robust Poisson regression models were applied to analyze the association of different SVN phenotypes with the risks of GDD and developmental delays in specific domains, with stratified analyses by sex. Results:Among the 25 860 infants, 13 719 (53.1%) were male and 12 141 (46.9%) were female. The gestational age at birth was 39.4 (38.6, 40.0) weeks. The overall detection rate of GDD at 1 year of age was 3.7% (962/25 860). The rates of delay across developmental domains, in descending order, language in 8 134 cases (31.5%), gross motor in 4 488 cases (17.4%), personal-social in 1 271 cases (4.9%), adaptive in 1 262 cases (4.9%), and fine motor in 621 cases (2.4%). Compared with the reference group, preterm-AGA-LBW, preterm-SGA-LBW, preterm-AGA-noneLBW, and term-SGA-LBW phenotypes were all associated with an increased risk of GDD, with the adjusted RR (95% CI) of 6.07(5.01-7.35), 4.81(3.11-7.46), 2.10(1.54-2.88) and 1.89(1.29-2.76) respectively.The preterm-AGA-noneLBW phenotype was all associated with an increased risk of delay in gross motor, language and personal-social functional domains (all P<0.05). The term-SGA-LBW phenotype was associated with an increased risk of delay in gross motor, fine motor and personal-social functional domains (all P<0.01). Whereas the term-LBW-only or term-SGA-only phenotype showed no statistically association with developmental delay in any functional domain (all P≥0.05). Conclusion:The combined classification based on gestational age and birth weight helps identify infants at high risk for neurodevelopmental delay at 1 year of age, suggesting that it may offer a reference for the rational allocation of clinical resources.

Objective:To investigate the association between small vulnerable newborn (SVN) phenotypes and the risk of neurodevelopmental delay at the age of 1 year.Methods:A prospective cohort study was conducted. A total of 25 860 singleton infants from "The Born in Guangzhou Cohort Study" who completed the Gesell developmental scale assessment at 1 year of age between January 2013 and June 2025 were included. Maternal sociodemographic characteristics, and other information were collected using a self-administered questionnaire, and maternal pregnancy-related information and neonatal birth data were extracted from medical records. Global developmental delay (GDD) was defined as a developmental quotient below 86 in ≥3 domains of the Gesell developmental scale, which assesses the adaptive, gross motor, fine motor, language, and personal-social domains. The random forest algorithm was employed for missing data imputation. Based on prematurity, small for gestational age (SGA), and low birth weight (LBW), newborns were categorized into 6 phenotypes: preterm-SGA-LBW, preterm-appropriate for gestational age (AGA)-LBW, preterm-AGA-nonLBW, term-SGA-LBW, term-LBW-only or term-SGA-only, and term-AGA-nonLBW phenotype. Among these, the first 5 were classified as SVN phenotypes, and the last one served as the reference group. Inter-group comparisons were performed using analysis of variance (ANOVA), χ2 tests, or Kruskal-Wallis test, as appropriate.?? Multivariable robust Poisson regression models were applied to analyze the association of different SVN phenotypes with the risks of GDD and developmental delays in specific domains, with stratified analyses by sex. Results:Among the 25 860 infants, 13 719 (53.1%) were male and 12 141 (46.9%) were female. The gestational age at birth was 39.4 (38.6, 40.0) weeks. The overall detection rate of GDD at 1 year of age was 3.7% (962/25 860). The rates of delay across developmental domains, in descending order, language in 8 134 cases (31.5%), gross motor in 4 488 cases (17.4%), personal-social in 1 271 cases (4.9%), adaptive in 1 262 cases (4.9%), and fine motor in 621 cases (2.4%). Compared with the reference group, preterm-AGA-LBW, preterm-SGA-LBW, preterm-AGA-noneLBW, and term-SGA-LBW phenotypes were all associated with an increased risk of GDD, with the adjusted RR (95% CI) of 6.07(5.01-7.35), 4.81(3.11-7.46), 2.10(1.54-2.88) and 1.89(1.29-2.76) respectively.The preterm-AGA-noneLBW phenotype was all associated with an increased risk of delay in gross motor, language and personal-social functional domains (all P<0.05). The term-SGA-LBW phenotype was associated with an increased risk of delay in gross motor, fine motor and personal-social functional domains (all P<0.01). Whereas the term-LBW-only or term-SGA-only phenotype showed no statistically association with developmental delay in any functional domain (all P≥0.05). Conclusion:The combined classification based on gestational age and birth weight helps identify infants at high risk for neurodevelopmental delay at 1 year of age, suggesting that it may offer a reference for the rational allocation of clinical resources.

Transfusion technicians constitute a core workforce in safeguarding blood safety, and the quality of their standardized training directly affects the operational efficiency of the blood services. At present, training programs for transfusion technicians across China have been developed in a diversified manner. Positive progress has been achieved in integrated theoretical and practical training, on-the-job faculty development, and regional collaborative training models. However, persistent challenges remain, including fragmented training providers, inconsistent training standards, limited coverage, and a disconnect between training and workforce utilization. Based on a review of current standardized training practice, this article systematically analyzes the structural challenges confronting current standardized training, and further proposes a framework for building a comprehensive training system, covering the definition and core components of standardized training, targeted improvement strategies and key assessment indicators. The study aims to facilitate the transformation of training for blood transfusion technicians in blood services from a project-based approach to an institutionalized model, and from fragmented implementation to a systematic framework.

AIM: To observe the influence of different intraocular lens implantation methods on visual quality in patients with cataract.METHODS: Retrospective study. Totally 85 patients(113 eyes)with cataract who received phacoemulsification combined with intraocular lens implantation in the hospital June 2020 to December 2023 were selected. According to the different implanted lenses, they were divided into monofocal group(42 cases, 55 eyes)and bifocal group(43 cases, 58 eyes). The uncorrected near visual acuity(UNVA), uncorrected intermediate visual acuity(UIVA), uncorrected distance visual acuity(UDVA), best corrected near visual acuity(BCNVA), best corrected intermediate visual acuity(BCIVA), best corrected distance visual acuity(BCDVA), contrast sensitivity(CS), objective visual quality, National Eye Institute 25-item Visual Function Questionnaire(NEI-VFQ-25)scores and complications were compared between both groups of patients at 3 mo after surgery.RESULTS:At 3 mo after surgery, the UNVA(LogMAR)of the bifocal group was significantly better than that of the monofocal group(0.24±0.06 vs 0.53±0.13, P<0.001), but there were no statistical differences in UIVA, UDVA, BCNVA, BCIVA and BCDVA between the two groups(all P>0.05). The 18 c/d spatial frequency scotopic CS in the bifocal group at 3 mo after surgery was significantly lower than that in the monofocal group(0.84±0.17 vs 0.92±0.22, P<0.05), while the CS in other frequency was not statistically significant(all P>0.05); the objective scatter index(OSI)was higher in the bifocal group than that in the monofocal group(P<0.05), while OV 20% and OV 9% were lower than those in monofocal group(all P<0.05), but there were no statistically significant differences in modulation transfer function cut off(MTFcut off), Strehl ratio(SR)and OV 100% between the two groups(all P>0.05). The scores of overall visual acuity and near visual activity in the bifocal group at 3 mo after surgery were higher than those in the monofocal group(all P<0.001), but there were no statistical differences in the scores of dimensions of overall health, distance visual activity, peripheral visual acuity, color vision, dependence degree, social function, social role and mental health between the two groups(all P>0.05). Furthermore, there were no statistical significance in the incidence of complications in the two groups(P>0.05).CONCLUSION: Phacoemulsification combined with bifocal intraocular lens implantation can provide more ideal near visual acuity and visual-related quality of life for patients with cataract, but its objective visual quality is worse, The two types of intraocular lenses have their own advantages and disadvantages, and it is still necessary to choose the appropriate intraocular lens according to the actual needs of patients.

AIM: To observe the influence of different intraocular lens implantation methods on visual quality in patients with cataract.METHODS: Retrospective study. Totally 85 patients(113 eyes)with cataract who received phacoemulsification combined with intraocular lens implantation in the hospital June 2020 to December 2023 were selected. According to the different implanted lenses, they were divided into monofocal group(42 cases, 55 eyes)and bifocal group(43 cases, 58 eyes). The uncorrected near visual acuity(UNVA), uncorrected intermediate visual acuity(UIVA), uncorrected distance visual acuity(UDVA), best corrected near visual acuity(BCNVA), best corrected intermediate visual acuity(BCIVA), best corrected distance visual acuity(BCDVA), contrast sensitivity(CS), objective visual quality, National Eye Institute 25-item Visual Function Questionnaire(NEI-VFQ-25)scores and complications were compared between both groups of patients at 3 mo after surgery.RESULTS:At 3 mo after surgery, the UNVA(LogMAR)of the bifocal group was significantly better than that of the monofocal group(0.24±0.06 vs 0.53±0.13, P<0.001), but there were no statistical differences in UIVA, UDVA, BCNVA, BCIVA and BCDVA between the two groups(all P>0.05). The 18 c/d spatial frequency scotopic CS in the bifocal group at 3 mo after surgery was significantly lower than that in the monofocal group(0.84±0.17 vs 0.92±0.22, P<0.05), while the CS in other frequency was not statistically significant(all P>0.05); the objective scatter index(OSI)was higher in the bifocal group than that in the monofocal group(P<0.05), while OV 20% and OV 9% were lower than those in monofocal group(all P<0.05), but there were no statistically significant differences in modulation transfer function cut off(MTFcut off), Strehl ratio(SR)and OV 100% between the two groups(all P>0.05). The scores of overall visual acuity and near visual activity in the bifocal group at 3 mo after surgery were higher than those in the monofocal group(all P<0.001), but there were no statistical differences in the scores of dimensions of overall health, distance visual activity, peripheral visual acuity, color vision, dependence degree, social function, social role and mental health between the two groups(all P>0.05). Furthermore, there were no statistical significance in the incidence of complications in the two groups(P>0.05).CONCLUSION: Phacoemulsification combined with bifocal intraocular lens implantation can provide more ideal near visual acuity and visual-related quality of life for patients with cataract, but its objective visual quality is worse, The two types of intraocular lenses have their own advantages and disadvantages, and it is still necessary to choose the appropriate intraocular lens according to the actual needs of patients.

OBJECTIVE To observe the effect of acupuncture combined with a modified Zhengan Xifeng Decoction on the early clinical symptoms and oxidative stress status of patients with hypertensive intracerebral hemorrhage(HICH)of liver-kidney yin defi-ciency syndrome.METHODS A total of 60 patients with hypertensive intracerebral hemorrhage(liver-kidney yin deficiency syn-drome)who successfully received 24-hour acute-phase treatment at the Department of Neurosurgery,Acupuncture and Rehabilitation Department,and wards of Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine(Kunshan Traditional Chinese Medi-cine Hospital)from July 2021 to January 2023 were recruited.A randomization table generated by SPSS 22.0 software was used to di-vide the patients into a control group and an observation group,with 30 patients in each group.The control group received symptomatic treatment,conventional rehabilitation training,and modified Zhengan Xifeng Decoction,while the observation group received additional acupuncture treatment on the basis of the control group.The treatment course was 1 month for both groups.Clinical effective rate,TCM syndrome scores,motor and neurological function scores[Activity of Daily Living(ADL)scale,National Institutes of Health Stroke Scale(NIHSS),Modified Ashworth Scale(MAS),Simplified Fugl-Meyer Assessment(FMA)scale],improvement in hematoma lesions,Fraction anisotropy(FA)ratio(rFA),and serum levels of antioxidant stress response factors Kelch-like ECH-associated protein 1(Keap1)and nuclear factor-E2-related factor 2(Nrf2)were observed before and after treatment in both groups.RESULTS After treat-ment,the clinical effective rate in the observation group was significantly higher than that in the control group(P<0.05);the TCM syn-drome scores in both groups decreased significantly(P<0.05),with the observation group showing better results than the control group(P<0.05);the ADL and FMA scores in both groups reduced significantly(P<0.05,P<0.01),while the NIHSS and Ashworth Scale scores increased significantly(P<0.05,P<0.01),with the observation group showing better improvement than the control group(P<0.05);serum Keap1 levels decreased significantly in both groups(P<0.01),while Nrf2 levels enhanced significantly(P<0.05,P<0.01),with the observation group showing better improvement than the control group(P<0.05);imaging studies showed that after treat-ment,the residual hematoma volume decreased significantly in both groups(P<0.05,P<0.01),and the rFA value increased signifi-cantly(P<0.05,P<0.01),with the observation group showing better results than the control group(P<0.01).CONCLUSION On the basis of standard treatment for the acute phase,acupuncture combined with Zhengan Xifeng Decoction can significantly improve the early clinical symptoms of HICH patients with liver-kidney yin deficiency,reduce oxidative stress levels,and promote the recovery of nerve and motor functions.

Objective:To investigate the application effect of the micro-lecture guided self-inquiry teaching mode in Medical Physics experiment course.Methods:Using cluster sampling,two classes(62 students,31 per class)from 18 administrative classes of grade 2021 majoring in Clinical Medicine at a medical college were selected.The original class structure was maintained,with random assignment to the control group(traditional teaching)and the experimental group(micro-lecture guided self-inquiry teaching).Both groups underwent comprehensive assessment and teaching satisfaction surveys,followed by comparative analysis.Results:The class performance,experimental report scores,practical assessment scores and total scores in the experimental group were all higher than those in the control group(P＜0.05).Satisfaction scores in the experimental group were higher in areas including relevance to practical application,teaching diversity,class discussion interactivity,collaborative learning format,improvement in practical skills,enhancement of self-directed learning and innovation abilities,stimulation of learning interest,and cultivation of scientific research thinking(P＜0.05).Conclusion:The micro-lecture guided self-inquiry teaching mode improves teaching effectiveness,enhances students'comprehensive competencies,increases teaching satisfaction,and aligns with the goal of cultivating application-oriented talents.

Objective:To evaluate the efficacy and safety of dupilumab in the treatment of moderate-to-severe atopic dermatitis (AD) in infants aged 6 months to 2 years.Methods:A prospective cohort study was conducted. Children aged 6 months to 2 years with moderate-to-severe AD were enrolled from the Department of Dermatology, Children′s Hospital of Chongqing Medical University between July 2022 and March 2023. Children weighing 5 to < 15 kg received subcutaneous injections of dupilumab at a dose of 200 mg every 4 weeks, while those weighing 15 to < 30 kg received subcutaneous injections of dupilumab at a dose of 300 mg every 4 weeks. Three age-matched healthy children were recruited as controls at the same time. Clinical assessments were performed at weeks 0, 2, 4, 8, 12, and 16 by using the parameters scoring AD (SCORAD), eczema area and severity index (EASI), investigator′s global assessment (IGA), body surface area (BSA) involvement, patient-oriented eczema measure (POEM), pruritus numerical rating scale (NRS), sleep NRS, and infants′ dermatitis quality of life (IDQoL) index. The primary efficacy endpoint was the proportion of patients achieving an IGA score of 0 or 1 (IGA0/1) at week 16, and the key secondary efficacy endpoint was the proportion of patients achieving at least 75% improvement from baseline in EASI (EASI75) at week 16. In addition, serum immunoglobulin (Ig) E, IgG, IgM, and IgA levels and peripheral blood eosinophil counts were measured at weeks 0, 4, and 16. Peripheral blood T helper (Th) cell subsets were analyzed in 10 AD patients and 3 healthy children at baseline by flow cytometry, and 6 AD patients underwent repeat testing at week 16. Adverse reactions were recorded throughout treatment. Changes in clinical scores over time after dupilumab treatment were analyzed using repeated-measures analysis of variance, and changes in serum total IgE levels were analyzed using generalized estimating equations.Results:A total of 12 children with AD were enrolled, including 8 males and 4 females, aged 1.5 ± 0.3 years, and the baseline SCORAD was 64.8 ± 9.9 points. Compared with baseline, SCORAD, EASI, IGA, BSA, POEM, pruritus/sleep NRS, and IDQoL scores were all significantly reduced at week 2 (all P < 0.05), and continued to decrease at weeks 4, 8, 12, and 16. At week 16, the IGA scores decreased from 3.9 ± 0.3 points at baseline to 1.7 ± 0.9 points, with 9 patients achieving IGA0/1; the EASI scores decreased from 28.1 ± 12.4 points at baseline to 4.9 ± 5.4 points, with 9 patients achieving EASI75. Compared with baseline, serum total IgE levels were significantly reduced at weeks 4 and 16 (Wald χ2 = 11.51, P = 0.003). At baseline, the proportion of Th2 cells among total CD3 +CD4 + T cells in patients was significantly higher than that in healthy controls (6.3% ± 1.3% vs. 4.3% ± 0.8%, t = 2.45, P = 0.032) ; at week 16, the proportion of Th2 cells in patients (5.3% ± 2.0%) was significantly lower than that at baseline ( t = 5.56, P = 0.003). The proportion of Th1/17 cells increased from 2.2% ± 1.5% at baseline to 3.9% ± 2.1% at week 16 ( t = 3.51, P = 0.007), whereas the proportions of Th1 and Th17 cell subsets showed no statistical significance compared with baseline (both P > 0.05). One patient experienced an injection-site reaction and another developed fever, but no treatment-related serious adverse reactions were observed. Conclusions:Dupilumab demonstrated favorable efficacy and safety in infants aged 6 months to 2 years with moderate-to-severe AD. In addition, dupilumab could decrease the proportion of Th2 cell subsets and serum levels of total IgE.

Objective:To evaluate the efficacy and safety of dupilumab in the treatment of moderate-to-severe atopic dermatitis (AD) in infants aged 6 months to 2 years.Methods:A prospective cohort study was conducted. Children aged 6 months to 2 years with moderate-to-severe AD were enrolled from the Department of Dermatology, Children′s Hospital of Chongqing Medical University between July 2022 and March 2023. Children weighing 5 to < 15 kg received subcutaneous injections of dupilumab at a dose of 200 mg every 4 weeks, while those weighing 15 to < 30 kg received subcutaneous injections of dupilumab at a dose of 300 mg every 4 weeks. Three age-matched healthy children were recruited as controls at the same time. Clinical assessments were performed at weeks 0, 2, 4, 8, 12, and 16 by using the parameters scoring AD (SCORAD), eczema area and severity index (EASI), investigator′s global assessment (IGA), body surface area (BSA) involvement, patient-oriented eczema measure (POEM), pruritus numerical rating scale (NRS), sleep NRS, and infants′ dermatitis quality of life (IDQoL) index. The primary efficacy endpoint was the proportion of patients achieving an IGA score of 0 or 1 (IGA0/1) at week 16, and the key secondary efficacy endpoint was the proportion of patients achieving at least 75% improvement from baseline in EASI (EASI75) at week 16. In addition, serum immunoglobulin (Ig) E, IgG, IgM, and IgA levels and peripheral blood eosinophil counts were measured at weeks 0, 4, and 16. Peripheral blood T helper (Th) cell subsets were analyzed in 10 AD patients and 3 healthy children at baseline by flow cytometry, and 6 AD patients underwent repeat testing at week 16. Adverse reactions were recorded throughout treatment. Changes in clinical scores over time after dupilumab treatment were analyzed using repeated-measures analysis of variance, and changes in serum total IgE levels were analyzed using generalized estimating equations.Results:A total of 12 children with AD were enrolled, including 8 males and 4 females, aged 1.5 ± 0.3 years, and the baseline SCORAD was 64.8 ± 9.9 points. Compared with baseline, SCORAD, EASI, IGA, BSA, POEM, pruritus/sleep NRS, and IDQoL scores were all significantly reduced at week 2 (all P < 0.05), and continued to decrease at weeks 4, 8, 12, and 16. At week 16, the IGA scores decreased from 3.9 ± 0.3 points at baseline to 1.7 ± 0.9 points, with 9 patients achieving IGA0/1; the EASI scores decreased from 28.1 ± 12.4 points at baseline to 4.9 ± 5.4 points, with 9 patients achieving EASI75. Compared with baseline, serum total IgE levels were significantly reduced at weeks 4 and 16 (Wald χ2 = 11.51, P = 0.003). At baseline, the proportion of Th2 cells among total CD3 +CD4 + T cells in patients was significantly higher than that in healthy controls (6.3% ± 1.3% vs. 4.3% ± 0.8%, t = 2.45, P = 0.032) ; at week 16, the proportion of Th2 cells in patients (5.3% ± 2.0%) was significantly lower than that at baseline ( t = 5.56, P = 0.003). The proportion of Th1/17 cells increased from 2.2% ± 1.5% at baseline to 3.9% ± 2.1% at week 16 ( t = 3.51, P = 0.007), whereas the proportions of Th1 and Th17 cell subsets showed no statistical significance compared with baseline (both P > 0.05). One patient experienced an injection-site reaction and another developed fever, but no treatment-related serious adverse reactions were observed. Conclusions:Dupilumab demonstrated favorable efficacy and safety in infants aged 6 months to 2 years with moderate-to-severe AD. In addition, dupilumab could decrease the proportion of Th2 cell subsets and serum levels of total IgE.

Objective:To investigate the short-term efficacy and safety of rituximab (RTX) in children with calcineurin inhibitor (CNI) resistant steroid resistant nephrotic syndrome (SRNS).Methods:A retrospective case analysis was conducted. Thirteen children with CNI resistant SRNS who were regularly treated with RTX (375 mg/m 2 per dose (maximum dose 500 mg), 1 dose per week, a total of 4 doses) in Department of Nephrology, Children′s Hospital of Fudan University from January 2016 to December 2023 were enrolled. The general data, disease related information, urinary protein/creatinine, serum albumin, blood creatinine before RTX treatment, immunosuppressants, adverse events, and monthly urinary protein/creatinine, serum albumin, and blood creatinine indexes within 6 months after RTX treatment were collected. The changes of urinary protein/creatinine, serum albumin and estimated glomerular filtration rate (eGFR) before and after RTX at 3 and 6 months were analyzed by using paired sample t test and Wilcoxon signed-rank test. Results:Among the 13 patients, 8 were male and 5 were female. The age of disease onset was 4.0 (2.9, 6.8) years and the age of RTX treatment was 9.8 (5.9, 13.6) years. There were 8 cases of focal segmental glomerulosclerosis, 3 cases of minimal change disease and 2 cases of mesangial proliferative glomerulonephritis. No clinically significant gene variation was detected in 12 cases and the other one did not receive gene test. Before RTX treatment, 11 cases were in chronic kidney disease stage G1, and 1 case each was in stage G2 and stage G3. Ten children completed 4 doses of RTX treatment, 1 patient completed 3 doses, and 2 patients completed 2 doses. Urinary protein/creatinine in 13 children at 3 and 6 months after RTX treatment was significantly lower than baseline (0.60 (0.13, 2.04), 0.49 (0.28, 1.10) vs. 1.44 (0.76, 4.11) mg/mg, Z=-2.34, -2.34, both P<0.05), and serum albumin was significantly higher than baseline ((35±8), (34±7) vs. (30±6) g/L, t=2.30, 2.60, both P<0.05). The eGFR at 6 months after RTX treatment was not significantly different from the baseline ((110±32) vs. (113±35) ml/(min·1.73 m 2), t=-0.76, P>0.05)). No serious adverse reactions occurred in this study. Conclusion:RTX could reduce urinary protein and increase serum albumin in short-term treatment in children with CNI resistant SRNS without significant side effects.