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.

In obstetrics, artificial intelligence (AI) technology has been applied to ultrasound examination, fetal heart monitoring, MRI, and other areas to improve diagnostic efficiency and accuracy. Although there exists limitations and challenges associated with its application, AI demonstrates substantial potential in obstetrics. Looking forward, it will be essential for healthcare professionals to collaborate closely with AI technologies to improve the quality of obstetric care collectively. Therefor, this paper reviews the research progress of AI in obstetrics.

Objective:To investigate the anemia conditions and characteristics of iron metabolism during different stages of pregnancy in women with different genotypes of thalassemia.Methods:This cohort study selected 3 303 singleton pregnant women who underwent regular prenatal examinations and genetic tests of thalassemia and were delivered at Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2019 to December 2023. According to the results of thalassemia gene testing, the women were divided into groups: those without thalassemia genes served as the control group (1 539 cases), and those with thalassemia genes (1 764 cases) were further divided based on genotype into the -α/αα group (326 cases), --/αα or -α/-α group (649 cases), point mutation α-thalassemia group (201 cases), β 0-thalassemia group (368 cases), β +-thalassemia group (91 cases), and α combined with β-thalassemia group (129 cases). Hemoglobin (Hb) and serum ferritin (SF) levels were measured in the first, second, and third trimester of pregnancy. Differences in anemia and iron reserves among the groups at different pregnancy stages were compared using repeated measures analysis of variance, LSD test, Kruskal-Wallis rank-sum test, and Bonferroni correction. Results:Compared to the first trimester, Hb levels decreased in the second and third trimester across all groups (LSD test, all P<0.05), and the severity of anemia increased (Bonferroni correction, all P<0.017). The severity of anemia varied among the groups at the same pregnancy stage ( Hfirst trimester=918.20, Hsecond trimester=1 224.50, Hthird trimester=980.19; all P<0.001), and Hb levels also differed ( Ffirst trimester=282.54, Fsecond trimester=352.31, Fthird trimester=239.02; all P<0.001). The β 0-thalassemia group had higher rates of moderate anemia in the first, second, and third trimester of pregnancy [38.6% (142/368), 85.3% (314/368), and 73.6% (271/368)] compared to other groups (Bonferroni correction, all P<0.002), and lower Hb levels [(102.1±8.9), (92.0±7.3), and (94.6±7.7) g/L] than other groups (LSD test, all P<0.05). As pregnancy progresses, SF levels in each group of pregnant women gradually decreased (LSD test, all P<0.05), and the degree of iron deficiency worsened (Bonferroni correction, all P<0.05). The iron deficiency rate in thalassemia pregnant women during the third trimester ranges from 21.5% (79/368) to 46.0% (150/326). The degree of iron deficiency varies among groups within the same gestational period ( Hfirst trimester=79.13, Hsecond trimester=203.98, Hthird trimester=130.55; all P<0.001), and SF levels also differ ( Ffirst trimester=17.28, Fsecond trimester=44.60, Fthird trimester=31.87; all P<0.001). Among them, the β 0-thalassemia group had the lowest iron deficiency rates in the second, and third trimesters [9.8% (36/368), and 21.5% (79/368)] (Bonferroni correction, all P<0.002). SF levels in the β 0-thalassemia and β +-thalassemia groups were higher than those in other groups during each gestational period (LSD test, all P<0.05). Conclusions:Pregnant women with thalassemia may experience varying degrees of iron deficiency during pregnancy, with the severity of iron deficiency and anemia increasing with gestational age. The degree of iron deficiency and anemia during pregnancy varies among pregnant women with different genotypes of thalassemia. Clinically, individualized management should be provided for pregnant women with thalassemia based on their genotypes, with dynamic monitoring of anemia and iron metabolism changes.

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.

This article reported a case of autosomal dominant intellectual developmental disorder type 22 caused by a heterozygous mutation in the ZBTB18 gene. At 24 +4 weeks of gestation, prenatal ultrasound indicated a short outer diameter of the fetal corpus callosum and bilateral ventricular dilatation. Whole-genome copy number variation analysis of the fetus showed no abnormalities. Whole exome sequencing (WES) and Sanger sequencing validation of the family revealed the fetus carried a c.1374_1383del(p.S459*) heterozygous mutation in the ZBTB18 gene (NM_205768.3), which was neither phenotypically present nor genotypically detected in the parents, suggesting a de novo mutation. Based on the clinical manifestations, the fetus was diagnosed with autosomal dominant intellectual developmental disorder type 22. After genetic counseling, the pregnant woman opted for termination of the pregnancy. This case highlights the correlation between prenatal ultrasonic detection of callosal dysgenesis and lateral ventricular enlargement and intellectual developmental disorders caused by gene mutations. Furthermore, it expands the mutation spectrum of the ZBTB18 gene, thereby facilitating prenatal diagnosis and genetic counseling.

Air leak syndrome is a common and critical respiratory issue in neonates. Air leak syndrome not only affects pulmonary gas exchange but also leads to unstable hemodynamics, severe pulmonary hypertension, and other life-threatening conditions. In recent years, despite significant improvements in respiratory support concepts, equipment, and techniques, air leak syndrome remains a prevalent clinical problem, impacting neonatal prognosis and quality of life. This article summarizes the research progress on high-risk factors, early diagnosis, prevention, and treatment of air leak syndrome.

This paper reported a type 1 diabetes patient who had severe diabetic nephropathy, retinopathy, hypertension, and hypothyroidism before pregnancy. The patient's blood glucose control was poor before pregnancy, and the complications were not properly treated. This was an unintended pregnancy, with a pre-pregnancy glycated hemoglobin A1c of 7.8% and early pregnancy urine protein of 3.81-4.53 g/24 h. Considering the patient's poor blood glucose control before pregnancy and the lack of proper treatment for multiple complications including nephropathy, a multidisciplinary consultation at an external hospital recommended termination of the pregnancy. However, the patient was determined to continue the pregnancy and was referred to Peking University First Hospital. Through strict blood glucose control, monitoring and evaluation of complications, and comprehensive management, the patient's blood glucose and blood pressure were well controlled during pregnancy. Regular monitoring of urine protein, renal function, and ocular fundus was conducted. At 31 weeks and 4 days of gestation, the patient's 24-hour urine protein significantly increased. After promoting fetal lung maturity, a cesarean section was performed at 34 weeks and 1 day of gestation, resulting in a successful delivery with good maternal and neonatal outcomes. At the 42-day postpartum follow-up, the patient's blood glucose and blood pressure were stable, urine protein returned to pre-pregnancy levels, and the infant was in good general condition.