Objective:To analyze the association between standardized management of clinical research, initiated by investigators and guided by clinical research management policies in healthcare institutions, and changes in the research behavior of graduate students.Methods:Theses related to cardiovascular health published by graduate students in the Sichuan-Chongqing region of China between January 2019 and June 2024 were retrieved from the China National Knowledge Infrastructure database. Multilevel models were used to analyze changes in ethical compliance awareness, research methodology standardization, and academic collaboration of graduate students before and after policy implementation. Using Shapiro Wilk test and percentage representation.Results:Among the 712 theses included in this study, the proportion of studies with ethical review reports increased from 44.50% to 55.32% following the implementation of standardized management [odds ratio ( OR)=1.80, P=0.017]. Standardized management significantly improved the quality scores of cross-sectional studies and randomized controlled trials ( P<0.001), as well as significantly increased the frequencies of multi-center collaboration ( OR=2.84, P=0.001) and intra-provincial collaboration ( OR=2.80, P=0.001). Conclusions:Standardized clinical research management shows significant association with positive changes in the research behavior of graduate students. Further optimization of management measures is recommended to comprehensively enhance the clinical research capabilities of graduate students.

Objective:To investigate the value of ultra micro angiography（UMA）imaging in evaluating the inflammation activity of pediatric Crohn's disease（CD）patients.Methods:In this prospective study，71 pediatric CD patients confirmed by clinical symptoms，laboratory and ileocolonoscopical results who planed to accept infliximab injection treatments in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from April to December 2024 were included. The CD patients were included and divided into 3 groups according to the pediatric Crohn's disease activity index（PCDAI）score：inactive CD group（ n=44），mild CD group（ n=17），and moderate-to-severe CD group（ n=10）. Before treatment，pediatric CD patients underwent B mode ultrasound（BMUS），the parameters such as bowel wall thickness（BWT），bowel wall stratification，mesenteric lymph nodes（MLNs），and existence of mesenteric fat hypertrophy（MFH）were recorded. Color Doppler flow imaging（CDFI）and UMA were used to evaluate the blood flow in the most thickened diseased bowel wall using Limberg scores. The diffierences of the above parameters among the 3 groups were compared. The diagnostic performance of UMA and CDFI in assessing the inflammatory activity of pediatric CD was evaluated. Results:There were statistically significant differences in BWT among the 3 groups（all P<0.05）. However，there were no statistically significant differences in MLNs among the 3 groups（all P>0.05）. Compared with the inactive CD，there were statistically significant differences in bowel wall stratification and MFH in both the mild and moderate-to-severe CD groups（all P<0.05）. When assessing bowel wall blood flow signals using CDFI，there was no statistically significant difference in blood flow signals in the bowel wall of the mild CD compared with the inactive CD（ P>0.05）. However，the blood flow signals in the bowel wall of the moderate-to-severe CD was significantly increased（ P<0.05）. There was also statistically significant difference in blood flow signals in the bowel wall between the mild and moderate-to-severe CD groups（ P<0.05）. When assessing bowel wall blood flow using UMA，there were statistically significant differences in blood flow signals in the bowel wall among all 3 groups（all P<0.05）. As the degree of inflammation increased，the blood flow signals in the bowel wall also increased significantly. ROC analysis revealed that diagnostic performance of the UMA-BMUS model was significantly better than that of the CDFI-BMUS model（AUC 0.945 vs. 0.873，sensitivity 88.9% vs. 74.1%，specificity 97.7% vs. 95.5%；all P<0.05）. Conclusions:By sensitively depicting the low-velocity and tiny blood flow signals of the inflamed bowel wall，UMA is an effective noninvasive imaging method to make semi-quantitative evaluation of the activity of pediatric Crohn's disease.

Objective:To analyze the association between standardized management of clinical research, initiated by investigators and guided by clinical research management policies in healthcare institutions, and changes in the research behavior of graduate students.Methods:Theses related to cardiovascular health published by graduate students in the Sichuan-Chongqing region of China between January 2019 and June 2024 were retrieved from the China National Knowledge Infrastructure database. Multilevel models were used to analyze changes in ethical compliance awareness, research methodology standardization, and academic collaboration of graduate students before and after policy implementation. Using Shapiro Wilk test and percentage representation.Results:Among the 712 theses included in this study, the proportion of studies with ethical review reports increased from 44.50% to 55.32% following the implementation of standardized management [odds ratio ( OR)=1.80, P=0.017]. Standardized management significantly improved the quality scores of cross-sectional studies and randomized controlled trials ( P<0.001), as well as significantly increased the frequencies of multi-center collaboration ( OR=2.84, P=0.001) and intra-provincial collaboration ( OR=2.80, P=0.001). Conclusions:Standardized clinical research management shows significant association with positive changes in the research behavior of graduate students. Further optimization of management measures is recommended to comprehensively enhance the clinical research capabilities of graduate students.

Objective:To investigate the value of ultra micro angiography（UMA）imaging in evaluating the inflammation activity of pediatric Crohn's disease（CD）patients.Methods:In this prospective study，71 pediatric CD patients confirmed by clinical symptoms，laboratory and ileocolonoscopical results who planed to accept infliximab injection treatments in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from April to December 2024 were included. The CD patients were included and divided into 3 groups according to the pediatric Crohn's disease activity index（PCDAI）score：inactive CD group（ n=44），mild CD group（ n=17），and moderate-to-severe CD group（ n=10）. Before treatment，pediatric CD patients underwent B mode ultrasound（BMUS），the parameters such as bowel wall thickness（BWT），bowel wall stratification，mesenteric lymph nodes（MLNs），and existence of mesenteric fat hypertrophy（MFH）were recorded. Color Doppler flow imaging（CDFI）and UMA were used to evaluate the blood flow in the most thickened diseased bowel wall using Limberg scores. The diffierences of the above parameters among the 3 groups were compared. The diagnostic performance of UMA and CDFI in assessing the inflammatory activity of pediatric CD was evaluated. Results:There were statistically significant differences in BWT among the 3 groups（all P<0.05）. However，there were no statistically significant differences in MLNs among the 3 groups（all P>0.05）. Compared with the inactive CD，there were statistically significant differences in bowel wall stratification and MFH in both the mild and moderate-to-severe CD groups（all P<0.05）. When assessing bowel wall blood flow signals using CDFI，there was no statistically significant difference in blood flow signals in the bowel wall of the mild CD compared with the inactive CD（ P>0.05）. However，the blood flow signals in the bowel wall of the moderate-to-severe CD was significantly increased（ P<0.05）. There was also statistically significant difference in blood flow signals in the bowel wall between the mild and moderate-to-severe CD groups（ P<0.05）. When assessing bowel wall blood flow using UMA，there were statistically significant differences in blood flow signals in the bowel wall among all 3 groups（all P<0.05）. As the degree of inflammation increased，the blood flow signals in the bowel wall also increased significantly. ROC analysis revealed that diagnostic performance of the UMA-BMUS model was significantly better than that of the CDFI-BMUS model（AUC 0.945 vs. 0.873，sensitivity 88.9% vs. 74.1%，specificity 97.7% vs. 95.5%；all P<0.05）. Conclusions:By sensitively depicting the low-velocity and tiny blood flow signals of the inflamed bowel wall，UMA is an effective noninvasive imaging method to make semi-quantitative evaluation of the activity of pediatric Crohn's disease.

Objective: We aimed to investigate whether 2-[ 18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[ 18F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy. Materials and Methods: This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[ 18F]FDG PET/CT for endoscopy-detected ampullary tumors 5–87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test. Results: The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in earlyphase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13–36.18;P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80–13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41–19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00–14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16–21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874–0.956] vs. 0.815 [0.732–0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816–0.967) in candidates for endoscopic papillectomy. Conclusion Adding 2-[ 18F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

Objective:To compare the effect of SMOF lipids composed of soybean oil, medium chain triglycerides, olive oil, and fish oil with medium-long chain mixed fat emulsions(Lipofundin) on parenteral nutrition-associated cholestasis(PNAC) in premature infants.Methods:Clinical data were collected from premature infants hospitalized in the neonatal intensive care unit of Shanghai Children′s Hospital from January 2018 to December 2019 with gestational age ≤34 weeks, birth weight ≤2 000 g, and duration of parenteral nutrition ≥14 days.They were devided into SMOF lipid group and Lipofundin group, and the incidence of PNAC, neonatal necrotizing enterocolitis(NEC), bronchopulmonary dysplasia(BPD), retinopathy of prematurity(ROP), periventricular-intraventricular hemorrhage(PVH-IVH), late-onset sepsis and liver function were compared between two groups.Results:The incidence of PNAC in the SMOF lipid group was significantly lower than that in Lipofundin group( P=0.042). The average level of ALT and AST in SMOF lipid group were markedly lower than those in Lipofundin group( P<0.05). The time to reach full enteral feeding of SMOF lipid group was shorter than that of Lipofundin group( P=0.005). There was no significant difference in the incidence of NEC, BPD, ROP, PVH-IVH, and late-onset sepsis between two groups( P>0.05). Conclusion:Compared with lipofundin, SMOF lipid can reduce the incidence of PNAC in premature infants, and has no significant effect on the incidence of NEC, BPD, ROP, PVH-IVH and late-onset sepsis.

Objective To study efficacy and safety of continuous renal replacement therapy (CRRT) in the treatment of neonatal sepsis-related acute kidney injury (AKI).Method From June 2011 to June 2018,neonates with sepsis-related AKI hospitalized in the neonatal intensive care unit of our hospital and treated with CRRT were enrolled.Before CRRT,12 h,24 h,48 h after CRRT and by the end of CRRT,their clinical data including renal function,acid-base balance,electrolytes,blood pressure (BP)and the change of hemodynamic indexes were retrospectively analysed.The efficacy and safety of CRRT was evaluated.Kruskal-wallis H test was used for statistical analysis.Result A total of 9 cases of sepsis-related AKI neonates were enrolled in the study,all treated with continuous veno-venous hemofiltration dialysis.5 cases had oliguria,2 cases fluid overload and 2 cases shock.The duration of CRRT was 49 ～ 110 h (76.2 ±23.5) h.12 h after CRRT,BP were maintained at 40 ～60 mmHg and stable during the treatment,the blood pH value increased to 7.35 ～ 7.45 and the oxygenation index reached 200 mmHg.24 h after CRRT,the oxygenation index rose to more than 300 mmHg.Serum potassium,urea nitrogen and creatinine levels decreased significantly after 12 h of CRRT,and reached the normal range after 24 h of CRRT.After 24 h of CRRT,the urine volume significantly increased.Venous catheterization was performed successfully in 9 cases.2 cases had thrombocytopenia,1 case catheterization obstruction and 1 case hypotension during CRRT.No complications such as hypothermia,hemorrhage,thrombosis or infection occurred.All 9 patients were cured and discharged.Conclusion CRRT is safe and effective for the treatment of neonatal sepsis-related AKI.

Objective To study the clinical efficacy and safety of extracorporeal membrane oxygenation (ECMO) in critically ill neonates.Method From November 2016 to September 2018,the clinical data of 5 cases who received ECMO treatment in NICU of our hospital were retrospectively analyzed.The indication of ECMO was reversible respiratory failure irresponsive to conventional therapy.The treatment mode was V-A ECMO.Oxygenation index (OI),vasoactive-inotropic score,blood lactate before and 24 h after ECMO were recorded.Complications of ECMO were also studied.Paired t-test was used to compare the pre and post treatment parameters.Result Among the 5 cases,4 cases were male and 1 case was female.3 cases were diagnosed with meconium aspiration syndrome,2 cases pulmonary hypertension.OI[(9.5 ± 1.8) vs.(60.6 ± 19.4)],vasoactive-inotropic score[(19.5 ± 12.0) points vs.(204.0 ± 143.8) points]and blood lactate [(2.8 ± 1.5) mmol/L vs.(9.6 ± 3.6) mmol/L]) were all significantly decreased at 24 h after ECMO treatment (P ＜ 0.05).During follow-up,3 cases survived,2 cases died.All the 5 cases showed thrombocytopenia,3 cases developed renal failure and received continuous renal replacement therapy,1 case got intracranial hemorrhage.2 of the 3 survived cases developed neurological impairment and need long term follow-up and rehabilitation therapy.Conclusion ECMO treatment has remarkable effects on critically ill neonates and may actually save lives,but the risk of complications are quite high.

Objective To explore the efficacy of continuous renal replacement therapy (CRRT) in the treatment of neonatal acute kidney injury (AKI).Methods Totally 17 critically ill neonates treated with CRRT were selected who were hospitalized at Department of Neonatology,Shanghai Children's Hospital,Children's Hospital Affiliated to Shanghai Jiaotong University,from June 2012 to June 2017,and among them there were 15 cases with AKI,and the clinical data of these 15 patients were retrospectively analyzed,while 15 AKI neonates were treated with CRRT combined with conventional treatment.The model for CRRT was continuous veno-venous hemofiltration dialysis (CVVH-DF) in 13 cases,plasma exchange (PE) in 2 cases.The changes of blood pressure(BP),renal function,electrolyte,acid-base balance index and hemodynamic indicators were analyzed respectively before CRRT treatment,12 h,24 h,48 h after treatment and by the end of CRRT treatment.The efficacy of CRRT treatment was evaluated in these 15 AKI neonates.Results Gestational age of 15 AKI newborns was 33 +4-40 +1 weeks,admission day age was 2-28 days,birth weight was 2.25-4.00 kg.Primary diseases were severe asphyxia in 6 cases,neonatal septicemia in 5 cases,congenital hereditary metabolic disease in 2 cases,traumatic asphyxia in 1 case,and liver failure in 1 case.CRRT treatment persisted for 49-190 hours.BP value [(50.8 ± 6.57) mmHg(1 mmHg =0.133 kPa)] could reach normal level after 12 h CRRT treatment,and blood pH value (7.31 ± 0.25) increased significantly after 12 h CRRT treatment,while blood K+[(5.51 ±1.86) mmoL/L],urea nitrogen (BUN) [(9.5 ±3.7) mmol/L],creatinine(Cr) [(93± 14)μmol/L] significantly decreased after 12 h CRRT treatment,and reached the normal range [K + (4.78 ± 2.95)mmol/L,BUN (7.5 ±2.1) mmol/L,Cr (54 ± 13) μmol/L] after 24 h treatment,but urine volume[(0.8 ±0.2)mL/(kg· h)] significantly increased after 24 h treatment.Partial pressure of oxygen/fraction of inspired oxygen reached 200 mmHg after 12 h treatment and more than 300 mmHg after 24 h treatment.CRRT treatment of 15 AKI neonates turned out to be effective.Conclusions CRRT can effectively improve the internal environment of AKI neonates and reduce the death rate of neonatal AKI,which can provide an effective adjuvant treatment measures for the treatment of AKI neonates.

Objective To observe the effect of curcumin on behavior,blood brain barrier(BBB)and ex-pression of glial fibrillary acidic protein(GFAP)and cyclic nucleotide 3′phosphohydrolase(CNPase)in hippocam-pus of radiation injured brain(RIB)rats. Methods SD rats were divided into radiation group,treatment group and negative control group. RIB rats model were established by X ray,and rats in treatment group were treated by curcumin. Morris water maze test were taken to study learning memory of rats in each group. The expression of Ev-ans blue(EB)in brain tissue and the expression of GFAP and CNPase in hippocampus were detected to observe the effect of curcumin on the BBB of RIB rats. Results In RIB rats,learning memory were decreased significant-ly,permeability of BBB were increased. GFAP expression in brain tissue was increased,and CNPase was de-creased(P < 0.05). After the treatment of curcumin,learning memory of rats were improved,the permeability of BBB was decreased,GFAP was decreased,and CNPase expression was increased(P < 0.05). Conclusion Cur-cumin can significantly reduce the damage of BBB in RIB rats,decrease the expression of GFAP and increase the expression of CNPase in hippocampal,which indicate that curcumin has curative effect on radiation injured brain.