Objective:To investigate the risk factors for mortality in neonates with necrotizing enterocolitis (NEC).Methods:This retrospective cohort study included patients diagnosed with NEC at stage Ⅱ-Ⅲ (Bell's criteria) and admitted to the Neonatology Department of Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University from January 2017 to December 2022. According to the outcomes, these patients were divided into the mortality and survival groups. Perinatal conditions, clinical manifestations, disease status during hospitalization, and blood routine parameters at different time points after birth were compared between the two groups to analyze the risk factors for mortality of NEC. Statistical analysis was performed using independent-sample t-test, Mann-Whitney U test, Chi-square test (or Fisher's exact test), and multivariate logistic regression analysis. Results:(1) A total of 118 NEC cases were included, with 100 in the survival group and 18 in the mortality group. (2) The gestational age and birth weight were significantly lower in the mortality group than in the survival group [(28.9±4.2) weeks vs. (33.7±3.9) weeks, t=4.78; 940 g (685-1 275 g) vs. 1 830 g (1 352-2 368 g), Z=4.18; both P<0.05]. The incidence of neonatal asphyxia was higher in the mortality group [9/18 vs. 18% (18/100), χ2=7.13, P<0.05]. (3) Compared with the survival group, the mortality group had higher proportions of patients who were at NEC stage Ⅲ, accepted surgery, were treated with vasoactive drugs, had undergone invasive mechanical ventilation, or had metabolic acidosis, hyperlactatemia, shock, or hematochezia [17/18 vs. 24% (24/100), χ2=33.39; 17/18 vs. 31% (31/100), χ2=22.88; 16/18 vs. 22% (22/100), χ2=31.26; 16/18 vs. 39% (39/100), χ2=15.26; 18/18 vs. 28% (28/100), χ2=30.29; 16/18 vs. 20% (20/100), χ2=34.15; 17/18 vs. 21% (21/100), χ2=37.69; 9/18 vs. 82% (82/100), χ2=7.13; all P<0.05]. (4) The proportions of patients who developed late-onset sepsis, hemodynamically- significant patent ductus arteriosus, respiratory distress syndrome, or pulmonary hemorrhage were significantly higher in the mortality group than in the survival group [15/18 vs. 33% (33/100), χ2=16.01; 9/18 vs. 21% (21/100), χ2=5.32; 15/18 vs. 39% (39/100), χ2=12.08; 7/18 vs. 7% (7/100), χ2=11.94; all P<0.05]. (5) Within 24 h of birth, the levels of red blood cells and platelets were lower in the mortality group than in the survival group [4.1×1012/L (3.8×10 12/L-4.6×10 12/L) vs. 4.6×10 12/L (4.0×10 12/L-4.9×10 12/L), Z=2.04; (199.9±68.6)×10 9/L vs. (239.8±72.6)×10 9/L, t=2.16; both P<0.05]; at 6-8 d after birth, the levels of red blood cells, hemoglobin (Hb) and hematocrit (HCT) were lower in the mortality group than in the survival group [(3.2±0.5)×10 12/L vs. (3.9±0.8)×10 12/L, t=3.30; (111.2±19.2) vs. (138.1±28.3) g/L, t=3.51; (33.0±5.4)% vs. (40.9±8.1)%, t=3.61; all P<0.05]; at the diagnosis of NEC, red blood cell count, Hb level, HCT, and platelet count were lower in the mortality group than in the survival group [(3.3±1.0)×10 12/L vs. (3.8±0.8)×10 12/L, t=2.47; (102.8±28.8) vs. (124.4±26.3) g/L, t=3.59; 31.0% (25.9%-38.4%) vs. 37.2% (31.5%-43.7%), Z=2.62; 87.0×10 9/L (50.2×10 9/L-157.0×10 9/L) vs. 228.0×10 9/L (130.0×10 9/L-414.7×10 9/L), Z=3.78; all P<0.05], while mean platelet volume (MPV), platelet distribution width, and the differences in hemoglobin (ΔHb) and hematocrit (ΔHCT) between the first 24 h after birth and 6-8 d after birth were significantly higher in the mortality group than in the survival group [13.1 fl (11.4-13.6 fl) vs. 11.6 fl (10.7-12.4 fl), Z=3.26; 19.6% (13.9%-25.2%) vs. 14.8% (12.0%-18.6%), Z=2.76; 35.5 g/L (28.3-57.3 g/L) vs. 27.0 g/L (8.0-42.5 g/L), Z=2.20;11.5% (9.4%-16.3%) vs. 6.3% (2.2%-11.2%), Z=2.85; all P<0.05]. (6) Late-onset sepsis ( OR=5.568, 95% CI: 1.201-25.816), hyperlactatemia ( OR=6.702, 95% CI: 1.193-37.651), shock ( OR=10.616, 95% CI: 1.157-97.406) and MPV elevation at the diagnosis of NEC ( OR=2.769, 95% CI: 1.468-5.223) were independent risk factors, while gestational age ( OR=0.836, 95% CI: 0.708-0.986), and HCT at 6-8 d after birth ( OR=0.848, 95% CI: 0.759-0.947) were protecting fctors for death in NEC. Conclusions:Preterm infants with smaller gestational age are more prone to mortality of NEC. Early identification and management of late-onset sepsis, shock, and hyperlactatemia may reduce the risk of mortality in NEC.

Objective:To investigate the risk factors for mortality in neonates with necrotizing enterocolitis (NEC).Methods:This retrospective cohort study included patients diagnosed with NEC at stage Ⅱ-Ⅲ (Bell's criteria) and admitted to the Neonatology Department of Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University from January 2017 to December 2022. According to the outcomes, these patients were divided into the mortality and survival groups. Perinatal conditions, clinical manifestations, disease status during hospitalization, and blood routine parameters at different time points after birth were compared between the two groups to analyze the risk factors for mortality of NEC. Statistical analysis was performed using independent-sample t-test, Mann-Whitney U test, Chi-square test (or Fisher's exact test), and multivariate logistic regression analysis. Results:(1) A total of 118 NEC cases were included, with 100 in the survival group and 18 in the mortality group. (2) The gestational age and birth weight were significantly lower in the mortality group than in the survival group [(28.9±4.2) weeks vs. (33.7±3.9) weeks, t=4.78; 940 g (685-1 275 g) vs. 1 830 g (1 352-2 368 g), Z=4.18; both P<0.05]. The incidence of neonatal asphyxia was higher in the mortality group [9/18 vs. 18% (18/100), χ2=7.13, P<0.05]. (3) Compared with the survival group, the mortality group had higher proportions of patients who were at NEC stage Ⅲ, accepted surgery, were treated with vasoactive drugs, had undergone invasive mechanical ventilation, or had metabolic acidosis, hyperlactatemia, shock, or hematochezia [17/18 vs. 24% (24/100), χ2=33.39; 17/18 vs. 31% (31/100), χ2=22.88; 16/18 vs. 22% (22/100), χ2=31.26; 16/18 vs. 39% (39/100), χ2=15.26; 18/18 vs. 28% (28/100), χ2=30.29; 16/18 vs. 20% (20/100), χ2=34.15; 17/18 vs. 21% (21/100), χ2=37.69; 9/18 vs. 82% (82/100), χ2=7.13; all P<0.05]. (4) The proportions of patients who developed late-onset sepsis, hemodynamically- significant patent ductus arteriosus, respiratory distress syndrome, or pulmonary hemorrhage were significantly higher in the mortality group than in the survival group [15/18 vs. 33% (33/100), χ2=16.01; 9/18 vs. 21% (21/100), χ2=5.32; 15/18 vs. 39% (39/100), χ2=12.08; 7/18 vs. 7% (7/100), χ2=11.94; all P<0.05]. (5) Within 24 h of birth, the levels of red blood cells and platelets were lower in the mortality group than in the survival group [4.1×1012/L (3.8×10 12/L-4.6×10 12/L) vs. 4.6×10 12/L (4.0×10 12/L-4.9×10 12/L), Z=2.04; (199.9±68.6)×10 9/L vs. (239.8±72.6)×10 9/L, t=2.16; both P<0.05]; at 6-8 d after birth, the levels of red blood cells, hemoglobin (Hb) and hematocrit (HCT) were lower in the mortality group than in the survival group [(3.2±0.5)×10 12/L vs. (3.9±0.8)×10 12/L, t=3.30; (111.2±19.2) vs. (138.1±28.3) g/L, t=3.51; (33.0±5.4)% vs. (40.9±8.1)%, t=3.61; all P<0.05]; at the diagnosis of NEC, red blood cell count, Hb level, HCT, and platelet count were lower in the mortality group than in the survival group [(3.3±1.0)×10 12/L vs. (3.8±0.8)×10 12/L, t=2.47; (102.8±28.8) vs. (124.4±26.3) g/L, t=3.59; 31.0% (25.9%-38.4%) vs. 37.2% (31.5%-43.7%), Z=2.62; 87.0×10 9/L (50.2×10 9/L-157.0×10 9/L) vs. 228.0×10 9/L (130.0×10 9/L-414.7×10 9/L), Z=3.78; all P<0.05], while mean platelet volume (MPV), platelet distribution width, and the differences in hemoglobin (ΔHb) and hematocrit (ΔHCT) between the first 24 h after birth and 6-8 d after birth were significantly higher in the mortality group than in the survival group [13.1 fl (11.4-13.6 fl) vs. 11.6 fl (10.7-12.4 fl), Z=3.26; 19.6% (13.9%-25.2%) vs. 14.8% (12.0%-18.6%), Z=2.76; 35.5 g/L (28.3-57.3 g/L) vs. 27.0 g/L (8.0-42.5 g/L), Z=2.20;11.5% (9.4%-16.3%) vs. 6.3% (2.2%-11.2%), Z=2.85; all P<0.05]. (6) Late-onset sepsis ( OR=5.568, 95% CI: 1.201-25.816), hyperlactatemia ( OR=6.702, 95% CI: 1.193-37.651), shock ( OR=10.616, 95% CI: 1.157-97.406) and MPV elevation at the diagnosis of NEC ( OR=2.769, 95% CI: 1.468-5.223) were independent risk factors, while gestational age ( OR=0.836, 95% CI: 0.708-0.986), and HCT at 6-8 d after birth ( OR=0.848, 95% CI: 0.759-0.947) were protecting fctors for death in NEC. Conclusions:Preterm infants with smaller gestational age are more prone to mortality of NEC. Early identification and management of late-onset sepsis, shock, and hyperlactatemia may reduce the risk of mortality in NEC.

The pathogenesis of neonatal necrotizing enterocolitis (NEC) is still unclear. Toll-like receptor 4 (TLR4) signaling pathway, mediated by TLR4 in the intestinal epithelial cells, is considered to play an important role in activating inflammatory storm in NEC. This paper elaborates the association between NEC and the inhibition of TLR4 signal pathway and its upstream and downstream signal targets, critical pattern recognition receptors, and negative regulation of TLR4 by certain receptors to gain more insight into possible target interventions for NEC.

Objective To study the spatial and temporal mode of infectious TB transmission in Guangxi Zhuang Autonomous Region (Guangxi).Methods Data related to infectious TB case (Include smear and/or culture positive patients) in Guangxi were collected from the National Notifiable Disease Reported System (NNDRS) from 2010 to 2015.Spatial-temporal analysis and prediction were performed by SaTScan 7.0.2,GeoDa 1.8.12,R program v 3.3.1 and SPSS 19.0 software,using the time series model,Moran' s I global and local spatial autocorrelation (Empirical Bayes adjustment).Kulldorff ' s space-time scan statistics displayed by R software was used to identify the temporal and spatial trend of TB.Results The total number of infectious TB cases,collected from NNDRS was 76 151,and showing a decreasing trend on annual incidence (value of Chi-square for Linear trend=3 464.53,P-value=0.000).The forecast value of TB cases in 2016 was 7 764 (4 971-10 557),with peak in March,analyzed through the Winters' multiplicative model.The Moran' s I global Statistics was greater than 0 (0.257-0.390).TB cluster seemed to have been existed for several years.The most significant hot spots seemed to be mainly located in the central and western parts of Guangxi,shown by local spatial autocorrelation statistics and the result from space-time scanning.Counties or districts that located in the east parts of Guangxi presented the low-low relation (significant cold spots).The situation of infectious TB seemed migratory.Conclusions Our data showed an annual decreasing trend of incidence on infectious TB with temporal concentration in spring and summer.Main clusters (hot spots) were found to be located in the central and western parts of Guangxi.Hopefully,our findings can provide clues to uncover the real mode of TB transmission at the molecular-biological level.

Secretory IgA (SIgA) antibodies in external secretions play an important role in mucosal immune response. Polymeric SIgA was advantageous over monomeric IgA (mIgA) and IgG in several aspects. To express secretory IgA antibody against H5N1 virus, we constructed the secretory component and immunoglobulin J expressing plasmids and co-transfected the plasmids into the Chinese hamster ovary cells (CHO) stably expressing immunoglobulin A. Then we used Zeocin to select the positive clone cells, monoclonal cells stably secreting SIgA was screened through fold dilution method at last. The SIgA antibody secreted from the CHO cells was confirmed by Western blotting, which demonstrated that we had got the complete SIgA molecular. The successful expression of this polymeric anti-H5N1 SIgA in CHO cells will contribute to the production of recombinant SIgA as a preventive agent for infectious disease control.
Animals ; Antibodies, Viral ; biosynthesis ; genetics ; CHO Cells ; Cloning, Molecular ; Cricetinae ; Cricetulus ; Genetic Vectors ; Immunoglobulin A ; immunology ; Immunoglobulin A, Secretory ; biosynthesis ; genetics ; immunology ; Influenza A Virus, H5N1 Subtype ; immunology ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; immunology