Objective:To summarize the characteristics of hemodynamically significant patent ductus arteriosus (hsPDA) in very low birth weight (VLBW) preterm infants and evaluate the efficacy and safety of transcatheter PDA closure (TCPC).Methods:This was a retrospective study including five VLBW preterm infants who were diagnosed with hsPDA by echocardiography at Women and Children's Hospital, Qingdao University from January to December 2024 and underwent transcatheter closure after pharmacological therapy failure. Follow-up assessments were conducted at 6 months after operation to evaluate PDA closure status, survival outcomes, and the occurrence of complications. Descriptive statistical analysis was used to summarize the demographic characteristics and clinical data.Results:The cohort comprised three males and two females. The median gestational age was 28 (24-29) weeks, and the median birth weight was 1 000 (670-1 220) g. The median age and birth weight at surgery were 25 (13-36) d and 1 200 (810-1 400) g, respectively. The PDA diameter was 3.8 (2.3-4.1) mm. PDA closure was successfully achieved in all five infants using the Amplatzer Piccolo? occlude, with no major procedure-related complications. All patients were weaned from mechanical ventilation and discharged. At 6-month follow-up, all five infants survived with no residual shunt, left pulmonary artery stenosis, or aortic coarctation on echocardiography.Conclusions:TCPC is feasible and safe for VLBW preterm infants when pharmacological therapy is ineffective or contraindicated. Larger cohorts and extended follow-up are needed to assess long-term outcomes and potential complications.

Objective:To investigate the interventional effects and mechanisms of spermine and spermine derivative 1 (SD1) on human cytomegalovirus (HCMV) infection by establishing an HCMV-infected human bronchial epithelial (HBE) cell model.Methods:HBE cells were used as the study carrier and divided into four groups: a blank control group without HCMV, a control group with HCMV, a spermine group with HCMV and 2 mmol/L spermine, and an SD1 group with HCMV and 2 mmol/L SD1. Viral titers were measured using the 50% tissue culture infectious dose (TCID50) method. The expression of related proteins and genes was detected by enzyme-linked immunosorbent assay (ELISA), Western-blot, and reverse transcription quantitative polymerase chain reaction (RT-qPCR), and cellular reactive oxygen species (ROS) levels were measured using 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA). The above data were compared in multiple groups using one-way analysis of variance, and further pairwise comparisons were conducted using SNK- q test. Results:Compared with the blank control group, the control, spermine, and SD1 groups showed increased viral titers [(0.00±0.00) vs. (8.38±0.50), (6.75±0.46), (5.63±0.52)-log10 TCID50/100 μl; q=21.85, 15.87, and 11.06; all P<0.05]. Compared with the control group, the spermine and SD1 groups exhibited reduced viral titers ( q=5.98 and 10.79; both P<0.05). The SD1 group showed a further reduction compared with the spermine group ( q=4.82, P<0.05). ELISA and RT-qPCR results demonstrated that compared with the blank control group, the control, spermine, and SD1 groups exhibited elevated levels of cyclic guanosine monophosphate-adenosine mompho-sphate (cGAMP), interferon-β (IFN-β), IFN-β mRNA, myxovirus resistance gene 1 (MX1) mRNA, and interferon-stimulated gene 15 (ISG15) mRNA [cGAMP: (0.20±0.03) vs. (0.92±0.10), (1.45±0.09), (2.03±0.15) pmol/ml; IFN-β: (0.13±0.02) vs. (2.34±0.12), (3.50±0.10), (4.50±0.14) ng/ml; IFN-β mRNA: 10.26±1.53 vs. 403.10±15.01, 602.35±11.02, 778.67±24.13; MX1 mRNA: 1.02±0.06 vs. 198.33±7.41, 304.61±9.98, 401.25±10.53; ISG15 mRNA: 1.04±0.08 vs. 273.84±13.71, 396.35±15.20, 489.57±17.46; q=6.93, 12.02, 17.60; 18.43, 28.10, 36.43; 12.52, 19.02, 24.66; 14.30, 21.36, 28.28; 15.12, 20.12, and 25.02; all P<0.05]. Compared with the control group, the spermine and SD1 groups showed further increases in these markers ( q=5.10, 10.68; 9.67, 18.00; 6.50, 12.14; 7.06, 14.00; 5.00, and 9.90; all P<0.05). The SD1 group exhibited even higher expression than the spermine group ( q=5.58, 8.33, 5.64, 6.92, and 4.90; all P<0.05). Western-blot results revealed that compared with the blank control group, the control, spermine, and SD1 groups showed increased expression of phosphorylated TANK-binding kinase 1 (p-TBK1) and phosphorylated interferon regulatory factor 3 (p-IRF3) (p-TBK1: 0.10±0.01 vs. 0.31±0.02, 1.04±0.04, 1.54±0.04; p-IRF3: 0.24±0.02 vs. 0.37±0.02, 0.58±0.03, 1.09±0.04; q=6.57, 29.41, 45.09; 3.38, 8.72, and 21.88; all P<0.05). Compared with the control group, the spermine and SD1 groups exhibited stronger expression ( q=22.84, 38.52; 5.34, and 18.50; all P<0.05). The SD1 group showed further enhancement compared with the spermine group ( q=15.68 and 13.16; both P<0.05). ROS levels were higher in the control group than in the blank control group (1 180.00±16.33 vs. 2 126.67±71.94; q=16.90, P<0.05). Compared with the control group, the spermine and SD1 groups showed reduced ROS expression (2 126.67±71.94 vs. 1 660.00±45.17, 1 473.23±55.58; q=7.30 and 11.66; both P<0.05). The SD1 group exhibited further reduction compared with the spermine group ( q=4.36, P<0.05). Conclusions:In the HCMV-infected HBE cell model, the addition of spermine and SD1 promoted the activation of the cGAMP synthase and type Ⅰ interferon signaling pathway, thereby enhancing innate immune suppression of HCMV infection. Meanwhile, it scavenged ROS to alleviate oxidative stress-induced cellular damage.

Glucocorticoids play a critical role in initiating parturition in most mammals, including humans. In humans, their labor-promoting mechanisms primarily involve promoting estrogen and prostaglandin synthesis, inducing functional progesterone withdrawal, and facilitating membrane rupture. However, the administration of synthetic glucocorticoids—whether intramuscular, intravenous, or intra-amniotic—can variably trigger labor and may even contribute to the development of fetal programming of adult diseases. Clinically, synthetic glucocorticoids are primarily used in threatened preterm pregnant women to enhance fetal lung maturation and improve neonatal outcomes, rather than to intervene in the delivery process. Therefore, strict control over the timing and dosage of synthetic glucocorticoids is essential to balance their benefits for fetal lung development against the risks of unintended labor induction.

This report described a case of hereditary thrombotic thrombocytopenic purpura (TTP) with neonatal onset. The infant presented with facial petechiae, jaundice, progressive thrombocytopenia, and persistent bleeding at puncture sites shortly after birth. Plasma ADAMTS13 activity was<1%. Whole-exome sequencing identified heterozygous variants in ADAMTS13: c.3121C>T and c.1869delT, inherited from the father and mother, respectively. The infant improved following exchange transfusion and phototherapy. Post-discharge, prophylactic fresh frozen plasma infusion was administered every 3-4 weeks. At the 2-year follow-up, no abnormalities were observed. This case highlights the importance of early recognition and intervention in neonates with unexplained thrombocytopenia, severe non-hemolytic jaundice, and anemia to ensure survival and improve prognosis.

Objective:To analyze the trends of preterm birth among women of advanced maternal age in Haidian District, Beijing from 2013 to 2022.Methods:A retrospective analysis was conducted on the birth registration data in Haidian District, Beijing, from January 2013 to December 2022, focusing on the records of women aged ≥35 who delivered between 22 and 44 weeks of gestation. The Joinpoint regression model was used to analyze the time trends of preterm birth rates among women of advanced maternal age in the Haidian District. Interrupted time series (ITS) analysis was applied to quantitatively evaluate the transient and long-term effects of China's universal two-child policy on the preterm birth rate among women of advanced maternal age.Results:(1) A total of 70 640 birth registration records from 68 587 women were finally included. The number of women giving birth peaked between 2016 and 2018 (8 158, 9 906, and 8 914 cases, respectively). The proportion of permanent residents in Beijing gradually decreased from 53.7% (2 175/4 049) in 2013 to 42.0% (4 160/9 906) in 2017 and then increased to over 98% between 2019 and 2022 [98.8% (7 828/7 925), 99.1% (6 283/6 340), 99.3% (5 970/6 014), and 99.5% (6 371/6 404), respectively]. (2) Among the 68 587 women, 57 339 (83.6%) were delivered at tertiary hospitals, and 35 496 (51.8%) were delivered by cesarean section. The proportion of multiple births increased slowly from 2.4% (236/9 906) in 2017 to 3.5% (225/6 404) in 2022. From 2013 to 2015, primiparous women accounted for the majority. Subsequently, the proportion of multiparous women increased annually, reaching 71.6% (6 385/8 914) in 2018 before gradually decreasing to 56.2% (3 600/6 404) in 2022. (3) A total of 70 640 live births were delivered. The highest number of deliveries was in 2017, with 10 139 cases. From 2013 to 2022, 36 995 male infants and 33 645 female infants were born, with preterm birth rates of 10.6% (3 914/36 995) and 9.4% (3 123/33 645), respectively. (4) Among the 70 640 infants, there were 124 extremely preterm infants (0.2%), 773 very preterm infants (1.1%), and 6 140 late preterm infants (8.7%), accounting for 1.8%, 11.0%, and 87.3% of all preterm infants (7 037 cases), respectively. (5) The optimal fitting results of Joinpoint regression indicated that the preterm birth rate showed a declining trend from 2013 to 2017 ( APC=－4.4%, 95% CI: -13.0% to -0.2%); with 2017 as the turning point, the preterm birth rate exhibited an upward trend from 2017 to 2022 ( APC=4.5%, 95% CI: 1.6% to 13.0%). (6) The results of ITS analysis revealed that the preterm birth rate instantly decreased by 0.79% ( β2=－0.79, P=0.026) in the month when the universal two-child policy took effect. In comparison, it increased by an average of 0.03% per month ( β3=0.07, P=0.001) after the implementation of the policy. After adjusting for the proportion of multiple births, the preterm birth rate significantly decreased before the policy took effect ( β1=－0.06, P=0.003), but increased by an average of 0.01% per month ( β3=0.07, P<0.001) after the policy took effect. There was no statistical significance in the transient impact of the policy on the preterm birth rate in this district ( β2=0.80, P=0.145). Conclusions:From 2013 to 2022, the preterm birth rates among women of advanced maternal age in Haidian District exhibit a "V"-shaped pattern with the implementation of the two-child policy as the turning point. It is necessary to continue strengthening maternal health care for women of advanced maternal age and ensure the targeted provision of related services to address the issue of increased preterm birth rates following the enforcement of the two-child policy.

Objective:To explore the molecular mechanism by which the methionine adenosyltransferase 2A (MAT2A)/β-catenin/zinc finger E-box binding homeobox 1 (ZEB1)/epithelial-mesenchymal transition (EMT) pathway regulates neural tube defect (NTD) through intracellular S-adenosylmethionine (SAM).Methods:A mouse NTD model was induced using the SAM metabolic disorder inhibitor ethionine. Eighty specific pathogen-free C57BL/6 mice were divided into three groups: a normal group (36 mice), an ethionine group (46 mice), and an ethionine+SAM group (44 mice). Phosphate-buffered saline (PBS), ethionine, and ethionine+SAM were respectively injected intraperitoneally on embryonic day 7.5 (E7.5), and the mice were sacrificed on E10.5. Embryonic tissues were collected, and the morphology of embryos in each group was observed under a stereomicroscope. The interaction between ethionine and MAT2A was analyzed using Autodock software. The expression levels of MAT2A, β-catenin, ZEB1, and EMT-related proteins in the brain tissues of embryos from the three groups were measured using immunofluorescence, immunohistochemistry, Western blotting, enzyme-linked immunosorbent assay (ELISA), and real-time quantitative polymerase chain reaction (RT-qPCR). Variance analysis was used for intergroup comparisons.Results:(1) Autodock analysis results showed that MAT2A binds to ethionine through covalent bonds, exhibiting a complementary effect, thereby accelerating the expression of MAT2A. (2) After successful construction of the NTD model, normal embryos were plump with well-developed brains. NTD embryos showed delayed development, obvious anencephaly, unclosed neural tubes, and asymmetry. (3) The levels of SAM and SAH in the embryonic tissues of the ethionine group were significantly lower than those in the normal group (1 737.56±95.64 vs. 872.33±205.11, and 89.17±9.50 vs. 51.25±9.48, respectively). The SAM and SAH levels in the ethionine+SAM group was 1 197.00±222.27 and 66.61±12.25, significantly higher than those in the ethionine group ( P<0.017). Compared with the normal group and the ethionine+SAM group, the expression of MAT2A mRNA in the embryonic brain tissue of the ethionine group was significantly upregulated (1.00±0.00, 1.59±0.52, and 2.42±0.53, respectively, F=49.64, P<0.001; pairwise comparisons between groups P<0.017). (4) Compared with the normal group, the expression of Ctnnb1 in the ethionine group was reduced, and the expression of Ctnnb1 in the ethionine+SAM group was higher than that in the ethionine group (1.00±0.00, 0.38±0.16, and 0.76±0.10, respectively, F=149.03, P<0.001; pairwise comparisons between groups P<0.017). (5) The expression of ZEB1 in the ethionine group was higher than that in the normal group and the ethionine+SAM group (2.91±0.55, 1.00±0.00, and 1.61±0.20, respectively, F=150.01, P<0.001; pairwise comparisons between groups P<0.017). (6) The expression levels of E-cadherin and Vimentin in the ethionine group were lower than those in the normal group. In contrast, the expression of N-cadherin was higher than that in the normal group. After SAM supplementation, the expression levels of E-cadherin and Vimentin were upregulated, and the expression level of N-cadherin was downregulated (0.54±0.12, 1.00±0.00, and 0.72±0.14, respectively, F=87.44; 0.53±0.17, 1.00±0.00, and 0.76±0.09, F=87.44; 3.11±0.53, 1.00±0.00, and 2.13±0.56, F=95.54; all P<0.001; pairwise comparisons within the same index group P<0.017]). Conclusions:Ethionine promotes the expression of MAT2A, leading to reduced SAM production. Ethionine regulates the level of ZEB1 by increasing MAT2A and inhibits the EMT process to interfere with methionine cycle metabolism, ultimately resulting in NTD.

Objective:To investigate the status of health economics evaluation studies on the core interventions in early essential newborn care (EENC).Methods:Relevant articles were retrieved from Chinese databases including CNKI, Wanfang Data, Yiigle, and VIP Chinese Journals using keywords in Chinese, including "early neonatal care," "resuscitation of birth asphyxia," "kangaroo mother care (KMC)" "neonatal vitamin K," "health economics," and "cost," "benefit," or "effect" and from databases such as PubMed, Embase, Springer, Google Scholar, and Web of Science using keywords such as "economic evaluation," "assessing," "cost," "cost-effective," "effective," "effect," "kangaroo mother care or KMC," "resuscitation of neonatal asphyxia/help baby breathe/neonatal asphyxia," "injection of vitamin K 1/intramuscular vitamin K 1 neonatal/newborns" and other core interventions in EENC. The retrieved literature was screened. The quality of the included articles was evaluated according to the Quality of Health Economic Studies (QHES) instrument. The research objects, types, main indicators, and results were summarized. Results:A total of 16 articles were finally included in this study, including nine related to KMC (of which two had no real-world data and were only statistical model studies), four related to neonatal resuscitation (all without real-world data), and three related to intramuscular injection of vitamin K 1 (of which one had no real-world data). No articles on other core interventions in EENC were retrieved. There were eight articles based on the analysis of previous health system or hospital data, four using a randomized controlled trial, two retrospective studies based on convenience sampling, and two comparing the effects before and after a project. Only two studies used the data from 2018 onwards. The 16 included articles were evaluated according to QHES and only three were rated as excellent. Regarding health economics evaluation of intervention measures, the included studies believed implementing KMC was more effective and less costly. Full resuscitation, selective resuscitation, and intramuscular injection of vitamin K 1 for newborns were cost-effective intervention measures. Conclusions:There are few health economics evaluation studies on EENC intervention measures, and the evidence of the studies is limited. In the future, the effects and health economic benefits of interventions in EENC in China can be predicted and analyzed by conducting high-quality randomized controlled studies or pre- and post-intervention comparative studies or using statistical methods such as establishing decision tree models to analyze the past data of hospital cases or from the health system.

This article reported two cases of pregnancy complicated by Kartagener syndrome treated at our institution. Both patients exhibited typical clinical features during pregnancy, such as cough and expectoration. They received individualized management, including airway clearance, expectorant therapy, postural drainage, inhalation of glucocorticoids, and antibiotic treatment. Both were successfully carried to full-term pregnancies. Case 1 was delivered vaginally, while Case 2 underwent cesarean delivery. The outcomes for both mother and child were favorable. Based on these two cases, it is concluded that the management of Kartagener syndrome during pregnancy should be individualized, particularly in genetic counseling, prenatal monitoring, and the selection of delivery methods, considering the patient's specific conditions and risks.

Objective:To investigate the predictive role of intrapartum ultrasound indicators on the difficulty of vacuum-assisted delivery.Methods:A prospective cohort study was conducted. The study subjects were singleton pregnant women hospitalized for delivery at the Third Affiliated Hospital of Sun Yat-sen University from February 2021 to December 2022, who had indications for vacuum-assisted delivery, and completed intrapartum ultrasound examination within 10 minutes before the procedure. Intrapartum ultrasound indicators included fetal position, angle of progression (AOP), and head-perineum distance (HPD). Based on the difficulty of vacuum-assisted delivery, the subjects were divided into easy and difficult groups. The fetal position, AOP, and HPD before vacuum-assisted delivery and delivery outcomes were compared between the two groups to explore the correlation and predictive value of intrapartum ultrasound indicators on the difficulty of vacuum-assisted delivery. Statistical and predictive value analyses were performed using independent-sample t-test, U-test, Chi-square (or Fisher's exact) test, logistic regression analysis, and receiver operating characteristic (ROC) curve. Results:A total of 162 cases were included in the study, with 120 in the easy and 42 in the difficult groups. The age of the 162 pregnant women ranged from 20 to 44 years, with an average of (30.6±3.9) years; 107 cases (66.0%) were first pregnancies, and 139 cases (85.8%) were primipara. (1) The fetal head stations in the difficult and easy groups were 2.3 (2.0-2.5) cm and 2.0 (2.0-2.5) cm, respectively, with no statistically significant difference ( P>0.05). The AOP during the interval and contraction periods and the ΔAOP in the difficult group were smaller than those in the easy group [ (138.1±8.8) vs. (143.8±7.9), t=3.89; (148.7±9.3) vs. (157.9±8.9), t=5.67; and (10.6±6.4) vs. (14.1±6.3), t=3.08; all P<0.01], while the HPD during the interval and contraction periods and ΔHPD in the difficult group were greater than those in the easy group [(3.4±0.5) cm vs. (3.2±0.4) cm, t=－2.69; (2.8±0.5) cm vs. (2.4±0.5) cm, t=－4.70; (－0.5±0.4) cm vs. (－0.8±0.5) cm, t=－2.83; all P<0.01]. (2) In the difficult group, seven cases required forceps delivery after 2-3 vacuum cup detachments; in the easy group, all cases were successfully delivered after 1-2 vacuum tractions. The duration of vacuum extraction was longer in the difficult group [7.0 (6.0-10.0) min vs. 3.0 (2.0-3.0) min, Z=9.65] (all P<0.001). (3) In the difficult group, four cases had severe maternal and neonatal delivery complications, including two cases of shoulder dystocia, one case of vesicovaginal fistula after failed vacuum extraction converted to forceps delivery, and one case of third-degree perineal tear after failed vacuum extraction converted to forceps delivery. In the easy group, one case had shoulder dystocia with mild neonatal asphyxia. The rate of vaginal tears in the difficult group was higher than in the easy group [47.6% (20/42) vs. 29.2% (35/120)] ( χ2=4.72, P=0.030). The incidence of postpartum hemorrhage in the difficult and easy groups was 11.9% (5/42) and 8.3% (10/120), respectively, with no statistically significant difference (Fisher's exact test, P=0.539). No cases required cesarean section after failed vacuum extraction. The incidence of scalp hematoma was higher in the difficult group than in the easy group [28.6% (12/42) vs. 11.7% (14/120), χ2=6.60, P=0.010]. The two groups had no statistically significant differences in the incidence of other neonatal complications. (4) Multivariate logistic regression analysis identified three independent variables associated with difficult vacuum extraction: maternal age, AOP and HPD during contraction. The ROC curve was used to test the predictive value of the multivariate model for difficult vacuum extraction, with an area under the curve of 0.808 (95% CI: 0.734-0.882) ( P<0.001). When the maximum Youden index (0.487) was taken, the sensitivity and specificity of the model in predicting difficult vacuum extraction were 0.762 (95% CI: 0.696-0.828) and 0.725 (95% CI: 0.656-0.794), respectively. Conclusions:AOP and HPD are related to the difficulty of vacuum extraction. The risk of difficult vacuum extraction increases with advanced maternal age, smaller AOP and larger HPD during the contraction phase.

This article reported a case of deafness, dystonia, and central hypomyelination (DDCH) caused by BCAP31 gene mutation. The patient was a 57-day-old male infant with obvious feeding difficulties, delayed growth and development, and elevated liver enzyme levels. Whole-exome sequencing revealed a de novo heterozygous mutation of c.32(exon2)delT/p.F11Sfs*34(NM_001256447) in the BCAP31 gene. His mother carried the heterozygous mutation, while his father had the wild-type gene. Based on clinical manifestations, a diagnosis of DDCH was made. The patient was treated with nutritional support, liver protection treatment, and symptomatic therapy and discharged at 93 days of age. A telephone follow-up two weeks after discharge reported that the infant still had feeding problems, had not gained any weight, cried a lot, and was hard to be soothed when crying. The infant died at 121 days of age.