OBJECTIVES: To explore the optimal maintenance dose of caffeine citrate for preterm infants requiring assisted ventilation and caffeine citrate treatment. METHODS: A retrospective analysis was performed on the medical data of 566 preterm infants (gestational age ≤34 weeks) who were treated and required assisted ventilation and caffeine citrate treatment in the neonatal intensive care unit of 30 tertiary hospitals in Jiangsu Province of China between January 1 and December 31, 2019. The 405 preterm infants receiving high-dose (10 mg/kg per day) caffeine citrate after a loading dose of 20 mg/kg within 24 hours after birth were enrolled as the high-dose group. The 161 preterm infants receiving low-dose (5 mg/kg per day) caffeine citrate were enrolled as the low-dose group. RESULTS: Compared with the low-dose group, the high-dose group had significant reductions in the need for high-concentration oxygen during assisted ventilation (P=0.044), the duration of oxygen inhalation after weaning from noninvasive ventilation (P<0.01), total oxygen inhalation time during hospitalization (P<0.01), the proportion of preterm infants requiring noninvasive ventilation again (P<0.01), the rate of use of pulmonary surfactant and budesonide (P<0.05), and the incidence rates of apnea and bronchopulmonary dysplasia (P<0.01), but the high-dose group had a significantly increased incidence rate of feeding intolerance (P=0.032). There were no significant differences between the two groups in the body weight change, the incidence rates of retinopathy of prematurity, intraventricular hemorrhage or necrotizing enterocolitis, the mortality rate, and the duration of caffeine use (P>0.05). CONCLUSIONS This pilot multicenter study shows that the high maintenance dose (10 mg/kg per day) is generally beneficial to preterm infants in China and does not increase the incidence rate of common adverse reactions. For the risk of feeding intolerance, further research is needed to eliminate the interference of confounding factors as far as possible.
Caffeine/therapeutic use* ; Citrates ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Respiration, Artificial ; Retrospective Studies

OBJECTIVE: To assess the efficacy and safety of mulberry twig alkaloids (Sangzhi alkaloids, SZ-A) for treatment of type 2 diabetes in a randomized, double-blind, placebo-controlled multicenter clinical trial. METHODS: A total of 200 patients were randomized to receive SZ-A (n=100) or placebo (n=100) for 16 weeks. The data analysis system for electronic data capture clinical trial central randomization system was used for randomization and dispensing of drugs. The primary outcome was the change in glycosylated hemoglobin (HbA1c) level. The secondary outcome included the proportions of cases with HbA1c <7.0% and HbA1c <6.5%, fasting blood glucose (FBG), postprandial blood glucose (PBG), area under curve for the PBG (AUC_0-2h), body weight, and body mass index (BMI). Adverse events (AEs), severe adverse events (SAEs), treatment-related adverse events (TAEs), gastrointestinal disorders (GDs), blood pressure, routine blood tests, and liver and kidney function were monitored. RESULTS: Compared with baseline, the change of HbA1c at week 16 was -0.80% (95% CI: -0.98% to -0.62%) and -0.09% (95% CI: -0.27% to 0.09%) in SZ-A group and placebo group, respectively. The proportion of patients with HbA1c <7% and <6.5% was higher in the SZ-A group than in the placebo group (46.8% vs. 21.6% and 29.9% vs. 10.8%). The observed values and changes in FBG, 1 h-PBG, 2 h-PBG, and AUC_0-2h differed significantly between groups (P<0.001), but differences were not significant in body weight and BMI (P>0.05). The incidence rates of AEs, TAEs, and GDs differed significantly between groups (P=0.010, P=0.005, and P=0.006, respectively), whereas the incidence rates of SAEs showed no significant differences between groups (P=1.000). CONCLUSION SZ-A are effective and safe for treatment of type 2 diabetes. The protocol was registered in http://www.chictr.org.cn/showproj.aspx?proj=60117 (ChiCTR2000038550).
Alkaloids ; Blood Glucose ; Diabetes Mellitus, Type 2/drug therapy* ; Double-Blind Method ; Glycated Hemoglobin A ; Humans ; Hypoglycemic Agents/therapeutic use* ; Morus ; Tablets/therapeutic use* ; Treatment Outcome

Objective: Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before Method: We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups. Results: The untreated PTB group had significantly lower clinical pregnancy (31.7% Conclusions Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.
Abortion, Spontaneous/epidemiology* ; Adult ; China/epidemiology* ; Embryo Transfer/statistics & numerical data* ; Female ; Fertilization in Vitro/statistics & numerical data* ; Humans ; Infertility, Female/etiology* ; Live Birth/epidemiology* ; Middle Aged ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology* ; Pregnancy Outcome/epidemiology* ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis, Pulmonary/epidemiology* ; Young Adult

Objective To describe the features of clinical,imaging and cerebral spinal fluid (CSF) of listerial rhombencephalitis to improve the understanding of this disease in clinical practice.Methods All the clinical data of three cases of listerial rhombencephalitis from April to August 2017 in Qilu Hospital were collected and analyzed retrospectively.Results All the three cases were healthy adult women before,with a rapidly progressive course,beginning with fever (38.2-40 ℃),headache accompanied by nausea and vomiting,followed by cranial paralysis,dysphagia and paralysis of the limbs on the 2nd to 5th day of onset,and developed to acute respiratory failure and unconsciousness on the 5th to 8th day of onset.All the three patients were diagnosed with CSF culture positive for Listera monocytogenes on the 3rd to 5th day after admission.The initial CSF lactic acid increased significantly,representing 12.3,12.0 and 10.0 mmol/L respectively;CSF white blood cells were 416× 106/L,760× 106/L and 793× 106/L,respectively,and the protein levels were 0.76 g/L,0.57 g/L and 1.47 g/L,respectively.Brain images showed brain stem was involved in all the three patients,therein cases 1 and 3 with cerebellar hemisphere involved,case 2 with upper cervical spinal cord involved,and case 1 with supratentorial hydrocephalus involved.After treatment with sensitive antibiotics,case 1 recovered,case 2 died,and case 3 lived with dysphagia.Conclusions Listerial rhombencephalitis should be suspected when a patient started with fever and headache,rapidly progressed to cranial nerve paralysis,brainstem symptoms,and acute respiratory failure,especially when the brain imaging suggested brainstem involved with increased white blood cells and apparently elevated lactic acid level of CSF.The earlier the sensitive antibiotics initiated,the better the patients' prognosis.

Objective To analyze the distribution of pathogens in the genital tract of infertile female,and comparing traditional methods with simultaneous amplification and testing (SAT) in the detection of UU,CT,NG and MG.Methods 467 female infertility patients were selected from the reproductive center of Suzhou Hospital Affiliated to Nanjing Medical University between June and September 2016 to analyze the distribution of UU,CT,MG and NG.The age was between 20 to 48 years old (mean 31.52±6.83 years old).352 cases of female patients with assisted reproductive technology were selected,aged from 21 to 46 years old (mean 30.67±6.67 years old).The swabs were tested by traditional methods or SAT.The sensitivity and specificity of the methods in detecting the pathogens were evaluated according to the experimental results.Results Among the 467 infertile women,the number of UU positive cases was the highest,the positive rate was 62.53％ (292/467),the positive rate of CT was 1.93％ (9/467) and the positive rate of NG was 0.21％ (1/467),and the positive rate of MG was 1.71％ (8/467).UU infection rate was higher in infertile women than normal control group 23.81％ (25/105) (x2 =52.01,P＜0.01).352 cases of female patients with assisted reproductive technology were selected for further analysis.For UU detection,the positive rate of swab samples detected by liquid culture was 48.9％,while the positive rate detected by SAT was 63.9％.Obviously the positive rate of SAT was higher than that of liquid culture.Swab culture and SAT results were analyzed by paired x2 test (x2 =41.93,P＜0.01).The positive rate of CT SAT was 1.71％,and the positive rate of CT-latex method was 0.28 ％.There was significant difference between CT latex method and SAT (Fisher exact probabilistic method statistical analysis,P＜0.005),which indicated that SAT method had a higher sensitivity.The positive rate (1.7 ％) and sensitivity (100％) of SAT were also higher than that of traditional method.Conclusion UU was the most common pathogen in female reproductive tract pathogens,followed by CT and MG.The SAT method has higher sensitivity than the conventional method in detecting of UU and CT.

Objective To evaluate the modified foruix-based technique with Guyton hook as an approach for the treatment of children with horizontal strabismus.Methods The clinical data of 128 patients (170 eyes) who underwent horizontal strabismus surgery between January 2014 and June 2017 were retrospectively reviewed,including 60 males and 68 females.The mean age was 1.5-17.0 (6.5 ± 1.6) years.All procedures under general anesthesia were performed using the modified fornix-based conjunctival incision with Guyton hook,and the follow-up period was 6 to 12 months.The clinical and cosmetic outcomes of strabismus surgery,the complications and interventions related to the incision were assessed.Results At 3 months after surgery,orthophoria with excellent cosmetics was achieved in 119 patients (93％) with the deviation ≤ ± 10△.Together 102 eyes (60％) had no intraoperative suture.Moreover,the incision was sutured with one stitch in 45 eye (26.5％),in 20 (11.8％) with 2 stitches,and in 3 (1.8％) with 3 stitches.During the follow up period,there was no severe intraoperative or postoperative complications.The swelling and redness of conjunctiva recovered quickly.Patients' discomfort was alleviated in a few days after the surgery.No oblivious scarring was found along the incision lines.Conclusion The modified fornix-based approach with Guyton hook is an effective and safe method for minimal incision surgery in children with horizontal strabis.

Objective: To investigate the prevalence of Ureaplasma urealyticum (UU) infection in infertile men, its influence on routine semen parameters and the distribution of antisperm antibody (AsAb) and its types in infertile patients with UU infection. METHODS: We detected the positive rate of UU infection, semen parameters, and the distribution of AsAb and its types in 662 infertile men and 25 normal fertile male controls followed by comparison of the obtained data between the two groups of subjects. RESULTS: The positive rate of UU infection was significantly higher in the infertile men than in the normal controls (52.87% ［350/662］ vs 16.00% ［4/25］, χ2 = 11.68, P <0.05). The semen volume, sperm count, sperm concentration and percentage of progressively motile sperm were remarkably lower in the UU-positive infertile males than in the control group (P <0.05). No statistically significant difference was observed between the UU-positive and UU-negative groups in the positive rates of total AsAb (43.4% vs 36.5%, χ2 = 3.25, P >0.05) and AsAb IgA, IgM and IgG in the seminal plasma, or in the percentages of serum AsAb IgM (16.9% vs 20.5%, χ2 = 1.22, P >0.05) and IgG (32.7% vs 28.9%, χ2 = 0.99, P >0.05) except in that of serum AsAb IgA (23.6% vs 17.0%, χ2 = 4.03, P <0.05). CONCLUSIONS The UU infection rate is high in infertile males, which decreases the semen volume, total sperm count, motile sperm concentration and percentage of progressively motile sperm and increases the positive rate of serum AsAb IgA.
Antibodies, Bacterial ; analysis ; Humans ; Infertility, Male ; immunology ; microbiology ; Male ; Semen ; Sperm Count ; Spermatozoa ; immunology ; Ureaplasma Infections ; diagnosis ; immunology ; Ureaplasma urealyticum ; immunology

Objective To observe the retinal microstructure changes in patients with rhegmatogenous retinal detachment following vitrectomy procedures and its correlation with the best corrected visual acuity (BCVA).Methods Patients who were diagnosed with rhegmatogenous retinal detachment and underwent vitrectomy were recruited in this study.BCVA and optical coherence tomography (OCT) examination were performed at 1 week,1 month,3 months and 6 months after operation for recording the neurosensory retinal thickness and outer nuclear layer thickness as well as observing the occurrence of ellipsoid zone,external limiting membrane rupture,macuiar edema,macular epiretinal membrane.Results A total of 32 eyes from 31 patients were followed up,and the BCVA became better as the follow-up prolonged.Both neurosensory retinal thickness and outer nuclear layer thickness thickened from 1 week [(122.75 ± 111.84) μm and (79.06 ±76.67) μm] to 3 months [(163.28 ± 133.10) μm and (108.66 ± 120.40)μm],and slightly thinned at 6 months [(159.50 ± 99.26) μm and (99.22 ± 74.89) μm].AS follow-up went by,the occurrence rate of ellipsoid zone and external limiting membrane rupture were 68.8％ and 53.1％,65.6％ and 46.9％,56.3％ and 40.6％,50.0％ and 37.5％ at 1 week,1 month,3 months,6 months,respectively,and both variables were significantly correlation with the patients' BCVA.Conclusion The neurosensory retinal thickness and outer nuclear layer thickness in patients with rhegmatogenous retinal detachment became gradually thicker and the vision became better during follow-up.Meanwhile,the ellipsoid zone and external limiting membrane rupture are the key factors for patients' BCVA.

Hypertension is the leading risk factor for death resulted from cardiovascular diseases.According to the statistics,the number of patients with hypertension in China is 270 million.At present,15 classes and 69 drugs have been approved for the treatment of hypertension,however,the treatment rate and the control rate remain low.Therefore,the research tocusing on new antihypertensive drugs are how to effectively reduce the blood pressure in patients with refractory hypertension,reduce the target organ damage in patients with complications,and reduce adverse drug reactions.This paper summarized the recent research progress of anti-hypertensive drugs on the market or in development,so as to provide references for development and application of antihypertensive drugs.

Objective: Sperm DNA fragmentation (SDF) is widely used to predict male infertility and the methods of detecting SDF are varied. This study aimed to compare two methods of SDF detection and investigate the correlation between SDF and sperm quality. METHODS: Using sperm chromatin structure assay (SCSA) and sperm chromatin dispersion test (SCD), we detected SDF in 108 semen samples collected in the Center of Reproduction and Genetics of Suzhou Municipal Hospital. We compared the results of the two methods and analyzed the correlations of SDF routine semen parameters, sperm morphology and the age of the patients. RESULTS: A significant consistency was found in the SDF index (DFI) between the two methods (P<0.01). The DFI was correlated negatively with sperm motility, the percentage of progressively motile sperm, and that of morphologically normal sperm (P <0.01), but positively with the teratozoospermia index (P <0.01 in SCSA and P <0.05 in SCD). The DFI measured by SCSA showed a significantly positive correlation with the patients' age (P <0.01), but not that obtained by SCD. CONCLUSIONS The results of both SCSA and SCD play an important role in predicting sperm quality. As a clinical index, the DFI has a predictive value for male infertility. However, the results of different detecting methods vary widely, which calls for further studies on their standardization.
Chromatin ; genetics ; physiology ; DNA Fragmentation ; Humans ; Infertility, Male ; diagnosis ; Male ; Semen ; physiology ; Semen Analysis ; Sperm Motility ; Spermatozoa ; physiology ; ultrastructure