Objective:To explore the high-risk factors affecting the severity of neonatal necrotizing enterocolitis (NEC).Methods:This study involved 153 NEC patients admitted to the Neonatology Department of the Children's Hospital of Soochow University from January 1, 2017, to December 30, 2023. Based on the severity of NEC determined by Bell's criteria, these patients were divided into two groups: mild group (Bell stage Ⅱ, n=70) and severe group (Bell stage Ⅲ, n=83). Clinical data including general conditions, clinical treatment and disease status before the onset of NEC, laboratory test results, and perinatal conditions of the mothers were retrospectively collected. Univariate analysis (rank-sum test and Chi-square test) and multivariate analysis (logistic regression analysis) were used to explore the risk factors affecting the severity of NEC. Results:The proportion of infants with gestational age<37 weeks or birth weight<1 500 g, the rate of antibiotic usage, sepsis or shock were higher in the severe group than in the mild group [91.6% (76/83) vs. 75.7% (53/70); 55.4% (46/83) vs. 34.3% (24/70); 85.5% (71/83) vs. 71.4% (50/70); 55.4% (46/83) vs. 17.1% (12/70); 30.1% (25/83) vs. 8.6% (6/70); with χ 2 values of 7.22, 6.84, 4.57, 23.64, and 10.91, respectively, all P<0.05]. Furthermore, the severe group had a late initiation of breastfeeding and longer durations of peripherally inserted central catheter (PICC) placement and parenteral nutrition [2.00 d (1.00-2.00 d) vs. 1.00 d (1.00-2.00 d); 0.00 d (0.00-18.00 d) vs. 0.00 d (0.00-7.50 d); 14.00 d (5.00-21.00 d) vs. 10.50 d (0.00-18.25 d), with Z values of -2.90, -1.98, and -2.09, respectively, all P<0.05]. (2) Within 48 h before the onset, the severe group had higher proportions of infants with decreased white blood cell count, decreased platelet count, electrolyte imbalance, and metabolic acidosis than the mild group [53.0% (44/83) vs. 14.3% (10/70); 49.4% (41/83) vs. 10.0% (7/70); 38.6% (32/83) vs. 14.3% (10/70); 37.3% (31/83) vs. 14.3% (10/70), with χ2 values of 24.94, 27.38, 11.23, and 10.30, respectively, all P<0.05]. Besides, the levels of procalcitonin and C-reactive protein were higher in the severe group than in the mild group [2.31 ng/ml (0.26-11.71 ng/ml) vs. 0.22 ng/ml (0.00-2.19 ng/ml); 58.50 mg/L (14.34-125.25 mg/L) vs. 8.20 mg/L (0.23-34.56 mg/L), with Z values of -3.88 and -5.02, respectively, both P<0.05]. (3) Multivariate logistic regression analysis showed that prolonged duration of PICC placement, decreased platelet count, electrolyte imbalance, metabolic acidosis, and concurrent sepsis were independent risk factors affecting the severity of NEC [ OR (95% CI) values were 1.104 (1.020-1.196), 5.364 (1.667-17.253), 4.047 (1.171-13.986), 4.333 (1.290-14.556), and 3.290 (1.005-10.774), respectively, with all P<0.05]. Conclusions:Prolonged duration of PICC placement, concurrent sepsis, decreased platelet count, electrolyte imbalance, and metabolic acidosis in NEC patients are more likely to lead to severe cases. In clinical practice, attention should be paid to relevant indicators, and abnormal changes should be identified and intervened in a timely manner to reduce the occurrence of severe NEC.

Objective:To explore the high-risk factors affecting the severity of neonatal necrotizing enterocolitis (NEC).Methods:This study involved 153 NEC patients admitted to the Neonatology Department of the Children's Hospital of Soochow University from January 1, 2017, to December 30, 2023. Based on the severity of NEC determined by Bell's criteria, these patients were divided into two groups: mild group (Bell stage Ⅱ, n=70) and severe group (Bell stage Ⅲ, n=83). Clinical data including general conditions, clinical treatment and disease status before the onset of NEC, laboratory test results, and perinatal conditions of the mothers were retrospectively collected. Univariate analysis (rank-sum test and Chi-square test) and multivariate analysis (logistic regression analysis) were used to explore the risk factors affecting the severity of NEC. Results:The proportion of infants with gestational age<37 weeks or birth weight<1 500 g, the rate of antibiotic usage, sepsis or shock were higher in the severe group than in the mild group [91.6% (76/83) vs. 75.7% (53/70); 55.4% (46/83) vs. 34.3% (24/70); 85.5% (71/83) vs. 71.4% (50/70); 55.4% (46/83) vs. 17.1% (12/70); 30.1% (25/83) vs. 8.6% (6/70); with χ 2 values of 7.22, 6.84, 4.57, 23.64, and 10.91, respectively, all P<0.05]. Furthermore, the severe group had a late initiation of breastfeeding and longer durations of peripherally inserted central catheter (PICC) placement and parenteral nutrition [2.00 d (1.00-2.00 d) vs. 1.00 d (1.00-2.00 d); 0.00 d (0.00-18.00 d) vs. 0.00 d (0.00-7.50 d); 14.00 d (5.00-21.00 d) vs. 10.50 d (0.00-18.25 d), with Z values of -2.90, -1.98, and -2.09, respectively, all P<0.05]. (2) Within 48 h before the onset, the severe group had higher proportions of infants with decreased white blood cell count, decreased platelet count, electrolyte imbalance, and metabolic acidosis than the mild group [53.0% (44/83) vs. 14.3% (10/70); 49.4% (41/83) vs. 10.0% (7/70); 38.6% (32/83) vs. 14.3% (10/70); 37.3% (31/83) vs. 14.3% (10/70), with χ2 values of 24.94, 27.38, 11.23, and 10.30, respectively, all P<0.05]. Besides, the levels of procalcitonin and C-reactive protein were higher in the severe group than in the mild group [2.31 ng/ml (0.26-11.71 ng/ml) vs. 0.22 ng/ml (0.00-2.19 ng/ml); 58.50 mg/L (14.34-125.25 mg/L) vs. 8.20 mg/L (0.23-34.56 mg/L), with Z values of -3.88 and -5.02, respectively, both P<0.05]. (3) Multivariate logistic regression analysis showed that prolonged duration of PICC placement, decreased platelet count, electrolyte imbalance, metabolic acidosis, and concurrent sepsis were independent risk factors affecting the severity of NEC [ OR (95% CI) values were 1.104 (1.020-1.196), 5.364 (1.667-17.253), 4.047 (1.171-13.986), 4.333 (1.290-14.556), and 3.290 (1.005-10.774), respectively, with all P<0.05]. Conclusions:Prolonged duration of PICC placement, concurrent sepsis, decreased platelet count, electrolyte imbalance, and metabolic acidosis in NEC patients are more likely to lead to severe cases. In clinical practice, attention should be paid to relevant indicators, and abnormal changes should be identified and intervened in a timely manner to reduce the occurrence of severe NEC.

Objective:To investigate the quality of life (QoL) and its related influencing factors of patients undergoing laparoscopic hiatal hernia repair (LHHR).Methods:The retrospec-tive cohort study was conducted. The clinical data of 215 patients undergoing LHHR in Beijing Chaoyang Hospital of Capital Medical University from August 2020 to April 2022 were collected. There were 90 males and 125 females, aged (62±14)years. All patients underwent symptom scoring and quality of life assessment 6 months after LHHR. Measurement data with normal distribution were represented as Mean± SD, and comparison before and after operation within the group was conducted using the paired t test. Measurement data with skewed distribution were represented as M(range). Stepwise linear regression analysis was used for influencing factors analysis. Optimal model was selected based on Akaike information criterion. Results:(1) Treatment. Of 215 patients, 162 cases underwent LHHR+gastric fundus folding surgery (Dor surgery), and 53 cases underwent LHHR+reconstruction of HIS angle. The score of visual analogue scale (VAS) of heartburn symptoms in 215 patients 6 months after surgery was 0(range, 0-4), with the score of VAS of acid reflux symptoms was 0(range, 0-9), the score of VAS of belching symptoms was 0(range, 0-9), the score of VAS of chest pain symptoms was 0(range, 0-9), the score of VAS of early satiety symptoms was 0(range, 0-9), respectively. (2) Assessment of QoL before and after surgery. The score of MOS item short from health survey (SF-36) of physiological function in 215 patients before and after LHHR was 80±24 and 87±18, with the score of SF-36 of physiological functionality before and after LHHR was 49±45 and 68±38, the score of SF-36 of body pain before and after LHHR was 65±23 and 74±19, the score of SF-36 of general health condition before and after LHHR was 46±7 and 51±9, the score of SF-36 of vigour before and after LHHR was 67±19 and 75±17, the score of SF-36 of social function before and after LHHR was 71±24 and 81±18, the score of SF-36 of emotional function before and after LHHR was 60±45 and 77±33, the score of SF-36 of emotional health before and after LHHR was 68±19 and 76±17, the score of SF-36 of health change before and after LHHR was 33±19 and 57±28. There were significant differences in the above indicators before and after surgery ( t=-7.82, -8.73, -8.20, -10.08, -9.75, -8.83, -8.00, -9.88, -12.95, P<0.05). (3) Factors influencing physical compo-nent summary (PCS) and mental component summary (MCS) 6 months after LHHR. Results of multi-variate analysis showed that gender, age, mental disease, cerebral infarction, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery were independent factors influencing PCS 6 months after LHHR ( P<0.05), and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery were independent factors influencing MCS 6 months after LHHR ( P<0.05). Conclusions:LHHR can improve patients′ QoL. Gender, age, mental disease, cerebral infarc-tion, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery are independent factors influencing PCS 6 months after LHHR, and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery are independent factors influencing MCS 6 months after LHHR.

Objective:To investigate the quality of life (QoL) and its related influencing factors of patients undergoing laparoscopic hiatal hernia repair (LHHR).Methods:The retrospec-tive cohort study was conducted. The clinical data of 215 patients undergoing LHHR in Beijing Chaoyang Hospital of Capital Medical University from August 2020 to April 2022 were collected. There were 90 males and 125 females, aged (62±14)years. All patients underwent symptom scoring and quality of life assessment 6 months after LHHR. Measurement data with normal distribution were represented as Mean± SD, and comparison before and after operation within the group was conducted using the paired t test. Measurement data with skewed distribution were represented as M(range). Stepwise linear regression analysis was used for influencing factors analysis. Optimal model was selected based on Akaike information criterion. Results:(1) Treatment. Of 215 patients, 162 cases underwent LHHR+gastric fundus folding surgery (Dor surgery), and 53 cases underwent LHHR+reconstruction of HIS angle. The score of visual analogue scale (VAS) of heartburn symptoms in 215 patients 6 months after surgery was 0(range, 0-4), with the score of VAS of acid reflux symptoms was 0(range, 0-9), the score of VAS of belching symptoms was 0(range, 0-9), the score of VAS of chest pain symptoms was 0(range, 0-9), the score of VAS of early satiety symptoms was 0(range, 0-9), respectively. (2) Assessment of QoL before and after surgery. The score of MOS item short from health survey (SF-36) of physiological function in 215 patients before and after LHHR was 80±24 and 87±18, with the score of SF-36 of physiological functionality before and after LHHR was 49±45 and 68±38, the score of SF-36 of body pain before and after LHHR was 65±23 and 74±19, the score of SF-36 of general health condition before and after LHHR was 46±7 and 51±9, the score of SF-36 of vigour before and after LHHR was 67±19 and 75±17, the score of SF-36 of social function before and after LHHR was 71±24 and 81±18, the score of SF-36 of emotional function before and after LHHR was 60±45 and 77±33, the score of SF-36 of emotional health before and after LHHR was 68±19 and 76±17, the score of SF-36 of health change before and after LHHR was 33±19 and 57±28. There were significant differences in the above indicators before and after surgery ( t=-7.82, -8.73, -8.20, -10.08, -9.75, -8.83, -8.00, -9.88, -12.95, P<0.05). (3) Factors influencing physical compo-nent summary (PCS) and mental component summary (MCS) 6 months after LHHR. Results of multi-variate analysis showed that gender, age, mental disease, cerebral infarction, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery were independent factors influencing PCS 6 months after LHHR ( P<0.05), and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery were independent factors influencing MCS 6 months after LHHR ( P<0.05). Conclusions:LHHR can improve patients′ QoL. Gender, age, mental disease, cerebral infarc-tion, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery are independent factors influencing PCS 6 months after LHHR, and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery are independent factors influencing MCS 6 months after LHHR.

Objective:To evaluate the feasibility and safety of laparoscopic surgery of hiatal hernia with gastric volvulus.Methods:A retrospective study was conducted to analyze the clinical data of 29 cases of hiatal hernia with gastric volvulus undergoing laparoscopic mesh repair and fundoplication at Beijing Chao-Yang Hospital from Jun 2021 to Dec 2022. Fundoplication was performed according to esophageal motility. The general data, operation times, intraoperative blood loss, percentage of intrathoracic stomach, hernia and gastric volvulus classification, conversion to open surgery, post-operative hospital stay and complications, symptom improvement rate, post-operative satisfaction were analyzed.Results:Chronic obstruction symptoms were the most common complaint among the 29 patients. All the operations were done laparoscopicaly with no conversion case,19(65%) cases with type Ⅲ hiatal hernia, 20(70%)　cases with organoaxial gastric volvulus, average operating time was (110.2±33.3)min, average blood loss was (12.6±7.0)ml, percentage of intrathoracic stomach 75.9%±15.8%, length of hernia defect was (6.6±1.2)cm, width of hernia defect was (5.0±1.1)cm .Average post-operative hospital stay was (6.4±1.7) days, perioperative complications were pneumonia(7%) ,atelectasis(7%) and gastric motility disorder(3%). All the patients were followed up for 15 to 32 months, without report of patch infection, long-term chronic pain, intestinal obstruction and hernia recurrence. Postoperative symptom improvement rate was 90%,postoperative satisfaction rate was 90%.Conclusion:Laparoscopic surgery of hiatal hernia with gastric volvulus is a safe, feasible and effective method with satisfactory results.

Background and aim:Real-world data on the effectiveness and safety of treatment with the direct-acting antiviral agent-based regimen are limited on the Chinese mainland.The aim of this study was to conduct a multicenter,prospective,real-world study of ombitasvir/paritaprevir/ritonavir(OBT/PTV/r)combined with dasabuvir(DSV)in hepatitis C virus(HCV)genotype 1b-infected non-cirrhotic or compensated cirrhotic Chinese adult patients. Materials and methods:Genotype 1b-infected patients were enrolled at eight sites in China.Patients received 25/150/100 mg of OBT/PTV/r once daily combined with 250 mg of DSV twice daily for 8 weeks or 12 weeks.Sustained virological response at 12 weeks post-treatment(SVR12)and the incidence of adverse events were assessed.We have also evaluated the effect of intensive questioning of patients who were overdue for SVR12 testing.Intention-to-treat(1TT)and modified 1TT(mITT)populations were used in the analysis. Results:One hundred forty patients were included,among whom 90.0％(126/140)were newly diag-nosed,9.3％(13/140)had compensated cirrhosis,92.9％(130/140)received 12 weeks of treatment,and 7.1％(10/140)received 8 weeks of treatment.In the mITT population,the virological response rate at week 4 was 96.4％(108/112),and at the end of treatment was 100％(102/102).Among these patients,139 patients completed 12 weeks of treatment,and 73 patients were followed-up.All followed-up patients achieved SVR12.There was no adverse event-related discontinuation.Serious adverse events during treatment were reported in two(1.4％)patients,and none were considered to be drug-related.Sixty-six(47.1％)patients did not return to receive the HCV RNA test at 12 weeks post-treatment. Conclusions:The rate of SVR12 was consistent with Phase Ⅲ clinical studies.OBT/PTV/r combined with DSV showed effectiveness in Chinese adult patients,and both tolerability and safety profile were favorable.However,patient compliance should be further improved in the real world.

Objective: To evaluate the real-world safety and curative effect of ombitasvir combined with dasabuvir for the treatment of chronic hepatitis C 1b genotype infection in non-cirrhotic or compensated cirrhotic patients. Methods: A real-world research method was adopted, and the research was conducted at three medical centers of mainland China. Non- cirrhotic or compensated cirrhotic patients with HCV genotype 1b infection who were initially treated with IFN/PEG-IFN-alpha combined with ribavirin, and ombitasvir combined with dasabuvir for 8 or 12 weeks were taken. Sustained virological response (SVR) and the incidence of adverse events during treatment and follow-up were evaluated after 12 weeks of drug withdrawal at OBV/PTV/r 25/150/100mg once daily and DSV 250mg, twice daily. Median and range were used for description of non-normally distributed data. Results: 80 cases of GT1b were included in this study. Of these 88.8% (71/80) were newly diagnosed, 12.5% (10/80) were compensated cirrhotic, 97.5% (78/80) received 12 weeks treatment, and 2.5% (2/80) received 8 weeks treatment. The rate of HCV RNA negative at EOT (end of treatment) was 100% (64/64). A total of 67 patients completed the treatment within 12 weeks, and 43 patients returned to the hospital for further consultations, and SVR12 was 100%(43/43). No patient discontinued the drugs because of an adverse event during treatment. Conclusion In the real world, Ombitasvir combined with dasabuvir for the treatment of chronic hepatitis C 1b genotype infection in China has 100% rates of EOT and SVR12 with well- tolerability and safety.

Objective:The human parental brain is a discrete set of interacting brain circuits that related with child-care feelings and behaviors.The research on it can help us to understand the essence of human parent-child re-lationship formation.In order to provide materials for the research of human parental brain and related fields,the study is ready to establish a set of standardized Chinese Infant Affective Face Picture System.Methods:By using convenience sampling,a total of 360 infant facial expression pictures of 211 Chinese infants aged from 3 to 6 months were collected.After standard processing on the photos,196 unmarried and nulliparous college students re-cruited from two universities in Chongqing and Guiyang were asked to assess them.One hundred subjects assessed the emotion categories and intensity of the pictures,and other 96 subjects assessed the emotion valence,arousal and dominance of the selected pictures.Results:The Chinese Infant Affective Face Picture System,containing 117 hap-py,92 neutral,108 sad expression pictures,was established.At the same time,the corresponding average identifica-tion rate were 89%,77%,92%,the intensity were 5.83,5.15,and 6.19,the valence were 5.92,4.55 and 2.70,the arousal were 5.11,4.18,3.77,and the dominance were 5.02,4.93,and 4.91.The system could effectively stimu-late participants'emotional reactions.There were statistically significant differences in scores of the established va-lence,arousal and dominance index between the 3 kinds of expression pictures (Ps <0.01).Conclusion:The Chi-nese Infant Affective Face Picture System has higher reliability and validity.The system could be used as emotional stimulus materials for the study of parental brain or emotion researches.