Objective:To summarize the risk factors, clinical manifestations, diagnosis and treatment of limb thrombosis in neonates.Methods:The clinical data of 14 neonates with limb thrombosis were hospitalized in neonatology department at Shengjing Hospital of China Medical University from February 2012 to February 2022 were retrospectively analyzed.Results:All the 14 cases of limb thrombosis were premature infants, with an average gestational age of 29 weeks and 5 days(27 weeks and 3 days to 33 weeks and 1 day), including eight cases of arterial embolism and six cases of venous embolism.Among them, 13(92.9%) cases were diagnosed with infectious diseases such as septicemia or neonatal necrotizing enterocolitis within 48 hours before embolization, and all had a history of peripheral arterial and venous catheterization.During the early stage of embolization, limb artery embolism was characterized by weakened distal artery pulsation, pale skin, gradual cyanosis and even gangrene.Limb venous embolism was manifested as limb swelling, skin congestion and cyanosis, but the arterial pulsation was normal.Fourteen cases were confirmed by vascular ultrasound.All the eight cases with arterial embolization were treated with heparin anticoagulation, five of which were cured, with an effective rate of 62.5%.The average time of heparin use in five cases was 2.5 days(2-3 days). One patient was not effective after 2 days of heparin treatment, and recovered after thrombectomy.Another two cases had distal limb gangrene, and them were treated with heparin for 5 days and 7 days.All of the six cases with venous embolism were cured, of which four cases were treated with heparin for an average of 8.5 days(4-15 days), and the other two cases were cured after general treatment.There were no bleeding events in the 12 infants treated with heparin.Conclusion:Peripheral arterial and venous catheterization during infection of preterm infants is the most common cause of limb thrombosis.The smaller body weight and gestational age, the thinner blood vessels, the higher risk of occurrence.Vascular ultrasound is the most commonly used examination method for neonatal thrombosis, and heparin anticoagulant therapy is the most commonly used treatment measure.When the treatment effect of heparin is not good, other treatment methods should be sought.

Objective:To explore the clinical characteristics and risk factors of neonatal adrenal hemorrhage(NAH), and to improve the understanding, diagnosis and treatment of this disease.Methods:In this study, a retrospective nested case-control study was used to collect clinical data of neonates diagnosed with NAH from January 2011 to December 2021 in the Department of Neonatology, Shengjing Hospital of China Medical University, and telephone follow-up were conducted for them.NAH infants with manifestations of neonatal hyperbilirubinemia were selected as the case group, and the random number table method was used to select the neonatal hyperbilirubinemia infants with NAH excluded by imaging in the same period at a ratio of 1: 2 as the control group.Characteristics of the clinical data of the two groups were compared and analyzed by Logistic regression to explore the risk factors of NAH.Results:During the study period, a total of 31 cases of NAH were diagnosed, with an average gestational age of(37.6±2.2) weeks, including 19 males, 25 full-term infants, 6 cases with macrosomia, 30 cases with natural labor, 29 cases with hyperbilirubinemia, 8 cases with birth injury, 7 cases with asphyxia, 9 cases with bilirubin encephalopathy, 12 cases with sepsis, 13 cases with intracranial hemorrhage, 17 cases with anemia, 9 cases with respiratory disease, 5 cases with hyperkalemia, 6 cases with hyponatremia.The results of NAH ultrasonography showed that 8 cases of hematoma had medium and low echoes, 6 cases of mixed echoes, and 17 cases of liquid flocculent echoes with or without punctate echoes.Color Doppler flow imaging results showed no blood flow signal.There were 26 cases on the right side, 4 cases on the left side, and 1 case on both sides.A total of 26 cases were followed up.Ultrasonography showed that most haematomas were absorbed within 1 to 3 months and disappeared within 6 months.Twenty-nine cases were included in the case group and 58 cases in the control group.Univariate analysis showed that age, birth weight, macrosomia, mode of delivery, bilirubin encephalopathy, neonatal sepsis, abdominal distension, anemia, asphyxia, total bilirubin, indirect bilirubin, Hb and CRP were significantly higher than those in the control group( P<0.05). Multivariate logistic regression analysis showed that macrosomia( OR=7.415, 95% CI=1.342~40.956, P=0.022) and asphyxia( OR=12.075, 95% CI=1.293~112.736, P=0.029) were independent risk factors of NAH. Conclusion:NAH is common in naturally born full-term infants, with a lack of specific clinical manifestations.Unexplained persistent hyperbilirubinemia may be its first symptom, often accompanied by anemia and ion disturbance.A few infants may have adrenal insufficiency.Macrosomia and asphyxia may be the risk factors for the occurrence of NAH.

Monkeypox is a zoonotic disease caused by monkeypox virus infection. This disease primarily occurs in tropical rainforest regions of central and western Africa, and is occasionally exported to other regions. Since May 2022, multinational monkeypox outbreak has become the largest monkeypox outbreak in history outside Africa. This review summarizes progress in the etiology, epidemiology, laboratory detection, clinical diagnosis and treatment of monkeypox.

Objective:To investigate the dynamic expression of DNA damage repair protein Nijmegen breakage syndrome protein 1(NBS1) in the neonatal rats with bronchopulmonary dysplasia(BPD), and its influence on the development and progression of BPD.Methods:Newborn rats were randomly divided into the BPD model group( n=50) and the control group( n=50) within 12 h after birth.The inhaled oxygen concentration was 80%-85% in the model group, and the control group inhaled air.In the two groups, lung tissue samples were collected on days 1, 3, 7, 10 and 14, and isolated, purified and cultured alveolar epithelial type Ⅱ cells(AEC Ⅱ). We observed pulmonary morphological changes under light microscope and evaluated alveolar development degree by radiate alveolar counts(RAC). Immunohistochemistry and cell immunofluorescence were used to observe the localization and expression of NBS1.Western blot and real-time quantitative PCR were used to detect the expression level of NBS1. Results:Compared with the control group, the RAC value in the model group was decreased significantly from 7 d after birth(control group 7.58±1.24, model group 5.42±1.24, P<0.01). Immunohistochemistry showed that NBS1 protein was mainly located in the nucleus of alveolar epithelial cells.In the model group, NBS1 was mainly expressed in the nucleus on the 1st day.With the prolonged exposure time, the number of cytoplasmic staining cells increased and the expression in the nucleus decreased.Cell immunofluorescence farther showed that NBS1 protein was mainly located in the nucleus in AEC Ⅱ.Compared with the control group, cytoplasmic staining in model group was enhanced from 3 d, while nuclear staining was gradually weakened, and was mainly located in the cytoplasm at 14 d. Western blot results showed that the expression of NBS1 protein in the model group peaked at 1 d compared to the control group(control group 0.72±0.29, model group 1.28±0.22, P<0.01), and then gradually decreased, with lower expression at 14 d compared to the control group(control group 0.73±0.19, model group 0.49±0.11, P<0.05). Similarly, the mRNA expression level of NBS1 in the model group peaked at 1 d compared to the control group(control group 1.00±0.00, model group 1.18±0.06, P<0.01), and then gradually decreased, with lower expression at 14 d than that in the control group(control group 1.07±0.13, model group 0.76±0.11, P<0.05). Conclusion:In the neonatal rats with BPD, the down-regulation expression and nuclear enrichment disorder of NBS1 may affect the DNA damage response and be one of the mechanisms mediating the onset of oxidative stress damage in BPD.

Objective:To compare the head magnetic resonance imaging (MRI) changes and the distribution of pathogens of purulent meningitis in premature and full term infants.Methods:This retrospective study assessed clinical data in 43 cases of neonatal purulent meningitis with positive blood or cerebrospinal fluid bacterial culture admitted to the Neonatal Ward of Shengjing Hospital of China Medical University from January 2012 to November 2019.According to the gestational age, those patients were divided into the premature infant group and the full term infant group.The general situation, head MRI and pathogen characteristics of both groups were compared.Results:The incidence of premature rupture of fetal membranes in the premature infant group was higher than that in the full term infant group [50.00%(13/26 cases) vs.5.88%(1/17 cases)], the rate of cesarean section in the premature infant group was higher than that in the term infant group [61.54%(16/26 cases) vs.23.53%(4/17 cases)], and there were significant difference between the 2 groups ( χ2=9.011 and 5.969, respectively, all P<0.05). There was no significant difference between 2 groups in age of onset [(9.8±7.0) d vs.(8.9±5.5) d], diagnosis[(13.0±7.1) d vs.(10.2±6.1) d] and examination [(16.1±7.9) d vs.(13.1±6.5) d] (all P>0.05). The top 3 pathogens were Klebsiella pneumonia ( K. pneumoniae) in 14 cases, Escherichia coli ( E. coli) in 11 cases and Streptococcus agalactiae (GBS) in 7 cases. K. pneumoniae was the most common pathogen in premature infants, and GBS was the most common pathogen in term infants.In the first MRI, white matter injury (WMI) was the most common disease (19 cases), the abnormal rate of MRI in the premature infant group was 65.38% (17/26 cases), the incidence of intracranial hemorrhage in the premature infant group was higher than that in the term infant group, the abnormal rate of MRI in the term infant group was 52.94% (9/17 cases), and the incidence of cerebral infarction in the term infant group was higher than that in the premature infant group.The MRI positive rates of meningitis caused by K. pneumoniae, E. coli and GBS were 57.14% (8/14 cases), 72.73% (8/11 cases) and 71.43% (5/7 cases), respectively.Infants with K. pneumoniae infections suffered from the main complications of WMI and intracranial hemorrhage.Infants infected with E. coli were prone to WMI in the early stage and hydrocephalus in the late stage.Infants with GBS were prone to WMI and cerebral infarction in the early stage and cerebromalacia in the late stage. Conclusions:There were some differences in the distribution of pathogenic bacteria and head MRI changes between premature infants and term infants, and head MRI of purulent meningitis caused by different pathogenic bacteria.A thorough understanding of the distribution of pathogens and the characteristics of head MRI in premature and full term infants contributed to the early diagnosis, treatment and prognosis of this disease.

Neonatal seizure is one of the most common manifestations of newborns, which could lead to severe neurological sequelae, such as epilepsy, cerebral palsy, developmental delay, mental retardation and even death.The causes of neonatal seizures are the key factors contributing to prognosis.In addition, individual factors, types of seizure and EEG could affect the prognosis in varying degrees.Therefore, for patients with poor prognosis, early diagnosis and treatment could effectively improve the prognosis and reduce the mortality.

Bronchopulmonary dysplasia (BPD) is one of the most common complications of the respiratory system in preterm infants, particularly in infants with the gestational age<32 weeks or the birth weight<1 500 g. The incidence of BPD did not decrease during the last twenty years.It is characterized by alveolar and microvascular dysplasia, presenting with less alveolar counts, enlarged and simplistic structure and slight airway damage.BPD patients may be oxygen-dependent and need repeated mechanical ventilation for a long time after birth.The lung function of BPD patients included normal large airway function, small airway dysfunction and decreased compliance that may last well till adulthood.The incidence of respiratory symptoms like cough and wheeze, as well as respiratory diseases like inflammation and asthma significantly increased, and may even impair growth and the development of the neurological system.In some patients it may develop into the chronic lung disease in adulthood.

Objective: To explore the relationship between features of neonatal seizure and recent outcomes of patients with unexplained neonatal seizure, which may provide evidence for early assessment of prognosis. Methods: Forty-seven cases of unexplained neonatal seizure admitted to the Department of Neonatology in Shengjing Hospital of China Medical University from January 2014 to June 2018, were followed-up at the age of more than 6 months.According to the recent outcomes(recurrent seizures during non-neonatal period and levels of development when they were followed-up), the patients were divided into good recent outcomes group(34 cases)and poor recent outcomes group(13 cases). The general information, characteristics of seizure and EEG changes during neonatal period were analyzed retrospectively. Results: There was no significant difference in gender, gestational age, birth weight, onset of first seizure, type of seizure, duration of seizure, and interval of seizures between two groups(P>0.05). There were 11 cases in poor recent outcomes group and 30 cases in good recent outcomes group that finished EEG.Compared with patients with good recent outcomes, patients with poor recent outcomes had significantly more abnormal EEG, paroxysmal abnormal changes and paroxysmal abnormal changes with abnormal background activity(90.9% vs.43.3%, 63.6% vs.10.0%, 36.4% vs.6.7%), with statistically significant difference(P<0.05). Thirty-nine cases with recurrent seizures during non-neonatal period had significantly higher rate of dysplasia than the 34 cases that without recurrent seizures(50.0% vs.12.8%), with statistically significant difference(P<0.05). Conclusion The recent outcomes of unexplained neonatal seizure may be related the EEG changes, but not gender, gestational age, birth weight, features of seizure.The neonates with unexplained neonatal seizure whose EEG manifest as paroxysmal abnormalities, were more likely to get poor recent outcomes, such as recurrent seizures and(or)dysplasia during non-neonatal period.

Objective To investigate the dynamic expression of telomere repeat binding factor 1 (TRF1) and telomeric repeat binding factor 2 (TRF2) in the development and progression of bronchopulmonary dysplasia (BPD) in neonatal rats and to clarify its role in BPD alveolar dysplasia.Methods The neonatal rat BPD model (n =40) was induced by using neonatal SD rats with inhaled oxygen concentration of 85％.The control group was prepared by inhaled air (n =40).In the two groups,10 rats were randomly selected from 1 day,3 days,7 days,and 14 days after the experiment.The lung tissue samples were collected,HE staining was performed to observe the pathological changes,and the alveolar development degree was evaluated by radial alveolar counting (RAC).Immunohistochemistry was used to observe the localization and expression of TRF1 and TRF2.Western Blot and real-time quantitative PCR (RT-PCR) were used to detect the expression levels of TRF1 and TRF2 proteins and genes in lung tissue.Results Immunohistochemical staining showed that TRF1 was mainly localized in the nucleus of alveolar epithelial cells and bronchial epithelial cells.TRF2 protein was found in the nucleus and cytoplasm of alveolar epithelial cells and bronchial epithelial cells.The expression was significantly higher than that of the control group.Compared with the control group,the TRF1 and TRF2 proteins increased significantly from 1d (TRF1 in control group:0.163 ±0.022,in model group:0.251 ±0.022;TRF2 in control group:0.156 ±0.012,in model group:0.240 ±0.018) to 14d (TRF1 in control group:0.193 ± 0.024,in model group:0.230 ± 0.025;TRF2 in control group:0.225 ± 0.017,in model group:0.350 ±0.012) rather than the control group (P ＜ 0.05).The mRNA expression levels of TRF1 and TRF2 increased continuously from 1d to 7d of hyperoxia exposure (TRF1 in control group:0.946 ± 0.028,in model group:1.590 ± 0.228;TRF2 in control group:0.834 ± 0.083,in model group:1.783 ±0.262) and decreased at 14d (TRF1 in control group:2.217 ± 0.225,in model group:1.259 ± 0.217,P＜0.05;TRF2 in control group:2.143 ±0.250,in model group:0.997 ±0.199,P ＜0.05).Conclusion In the developmental stage of BPD,TRF1 and TRF2 act as negative regulators of telomere length,and protein levels are up-regulated,which suggest that they be involved in the pathological process of BPD alveolar dysplasia.

Objective To investigate the effects of cyclinA2 and its inhibitor p21 on alveolar development in bronchopulmonary dysplasia (BPD) neonatal rats.Methods Eighty newborn rats were randomly divided into a model group (FiO2 =80％-85％) and a control group (FiO2 =21％).The degree of alveolar development was evaluated by radial alveolar count (RAC) and alveolar septal thickness.The distribution and expression of cyclinA2 and p21 were detected by immunohistochemistry and Western blot.Results The RAC value of the model group was lower than that of the control group from 3 days.The thickness of the alveolar seprum was higher than that of the control group from 7 days (P ＜0.05).The expression of p21 protein in the model group began to increase from 3d,peaked on 14d,and lasted for 21d.The expression of cyclinA2 protein in model group was higher than that in control group at 14d and 21d (P ＜0.05).There was a negative correlation between RAC and p21 protein expression in model group (r =-0.5966,P ＜0.01),and no correlation with cyclinA2 (r=0.7276,P＞0.05);there was no correlation between RAC and p21 in the control group (r =-0.2929,P ＞ 0.05),and positively correlated with cyclinA2 (r =0.8476,P ＜ 0.01).The alveolar septal thickness of the model group and the control group were both positively correlated with p 21 (r =0.4291,P＜0.05;r=0.4447,P ＜0.05),and negatively correlated with cyclinA2 (r=-0.6814,P ＜0.01;r=-0.7636,P ＜0.01).Conclusion The imbalance of cell cycle regulatory protein cyclinA2 and its inhibitor p21 expression in neonatal rats exposed to hyperoxia may be one of the related factors that interfere with the development of BPD alveoli.