Gestational diabetes mellitus is one of the common complications during pregnancy，and its incidence is increasing with risk factors，screening and diagnostic criteria，which not only brings heavy psychological and economic burdens to pregnant women，but also increases the risk of abnormal lung development in offspring，which may delay the maturation of lung structure and function in offspring，resulting in pulmonary hypoplasia.The abnormal time and control of blood glucose during pregnancy，the regulation of promoting lung maturation，the sex of the fetus，and the infection during pregnancy are the risk factors which interfere with the lung development of offspring，and the choice of delivery time and mode also affect the respiratory system outcome to varying degrees.Therefore，it is very important to understand the lung development of offspring of mothers with gestational diabetes mellitus and analyze their lung development factors to optimize lung development outcomes.This paper mainly expounds the factors affecting the lung development of offspring of mothers with gestational diabetes mellitus and the short-term and long-term outcomes of lung development.

Objective:To explore the potential effect of peptide KLF14-P1 secreted from mesenchymal stem cells（MSCs）in bronchopulmonary dysplasia（BPD）.Methods:Low，medium and high doses of the paracrine peptide KLF14-P1 from MSCs were intraperitoneally injected into neonatal mice with BPD induced by hyperoxia. The pathological changes in lung tissue were observed，and the expression of surfactant protein C（SPC）in lung tissue was analyzed by immunofluorescence staining. Meanwhile，the levels of inflammatory factors in bronchoalveolar lavage fluid（BALF）and lung tissue，including tumor necrosis factor alpha（TNF-α），interleukin-1β（IL-1β），IL-6，and IL-10，were detected. And after pretreating with low，medium and high doses of KLF14-P1 for 24 hours，mouse lung epithelial cells MLE-12 were stimulated with H 2O 2 for 2 hours. The cell proliferation，levels of inflammatory factors（TNF-α，IL-1β，IL-6，IL-10），reactive oxygen species（ROS），and c-Jun N-terminal kinase（JNK）protein level were then detected. Results:The lung dry-to-wet weight ratio of the medium-dose KLF14-P1 group（0.202±0.011）and the high-dose KLF14-P1 group（0.209±0.010）of the newborn mice increased significantly compared with the BPD group（0.187±0.008）（ P<0.01）. Compared with the BPD group，the lung alveolar structure of the newborn mice in the medium-dose and high-dose KLF14-P1 groups improved significantly，and the levels of TNF-α，IL-1β，and IL-6 in lung tissue and BALF decreased，while IL-10 increased（all P< 0.01）. Compared with the H 2O 2 group（49.296%±0.980%），the survival rate of MLE-12 cells in the low-dose group（56.390%±0.810%），the medium-dose group（73.506%±2.504%），and the high-dose group（81.699%±1.554%）increased significantly，cell apoptosis decreased significantly，inflammatory factors TNF-α，IL-1β，and IL-6 decreased，and IL-10 level increased（all P<0.01）. Moreover，the ROS accumulation of cells in the low，medium，and high-dose KLF14-P1 groups was lower than that of the H 2O 2 group，and the phosphorylated JNK protein level decreased（all P<0.05）. Conclusion:KLF14-P1 alleviated the lung injury and inflammatory response in BPD mouse，possibly through the inhibition of the ROS/JNK pathway.

Premature infants are frequently prone to adverse pulmonary outcomes due to inadequate lung development.During the neonatal period，It is manifested as restrictive ventilatory impairments characterized by reduced lung volume and compliance，as well as obstructive ventilatory impairments marked by increased airway resistance.Although there is some improvement in lung volume and compliance from infancy to school age，varying degrees of persistent airway obstruction still exist，particularly in extremely preterm infants，which may persist into adulthood and lead to chronic pulmonary diseases.The techniques utilized for lung function test in premature infants differ in different age groups.School-age and adolescent children can employ the same test methods as adults.However，for preschool-aged children and particularly newborns，due to their tender age，limited capacity for complete cooperation and distinctive physiological characteristics，the current test techniques have not yet been widely implemented which are still in research.This article presents a comprehensive review of lung function characteristics and assessment methods at various stages of premature infants.

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

Objective:To investigate the application effect of the humble tutor mode in the teaching of nursing interns in operating room.Methods:A total of 40 nursing interns in the Operating Room of Affiliated Hospital of Jining Medical University from August 2020 to June 2021 were selected as control group, and 46 nursing interns from August 2021 to September 2022 were selected as experimental group. The interns in the control group received teaching with the conventional tutor mode, and those in the experimental group received teaching with the humble tutor mode. The two groups were compared in terms of the scores of theoretical knowledge and operation skills, voice behavior, self-efficacy, and humble tutor perception. SPSS 19.0 was used to perform the t-test, the chi-square test, and the correlation analysis. Results:At the time of department rotation, the experimental group had significantly higher scores of theoretical knowledge (93.86±3.53) and operation skills (90.90±5.68) than the control group ( P<0.001). Compared with the control group, the experimental group had significantly higher scores of voice behavior [(35.22±7.60) vs. (30.43±5.96), P=0.002], self-efficacy [(28.17±5.03) vs. (24.38±3.39), P<0.001], and humble tutor perception [(37.04±4.34) vs. (26.33±6.63), P<0.001]. Humble tutor perception was positively correlated with voice behavior ( r=0.89, P<0.001), self-efficacy ( r=0.72, P<0.001), operation skills ( r=0.66, P<0.001), and score of theoretical knowledge ( r=0.39, P=0.007). Conclusion:The humble tutor mode has a significant effect in operating room teaching and can improve the assessment scores of theoretical knowledge and operation skills, promote the formation of humble tutors, and strengthen the teaching effect of voice behavior and self-efficacy in nursing interns.

OBJECTIVE: To review the clinical features of a male twin affected with glutaric academia type I (GA-I) and analyze the variations of glutaryl-CoA dehydrogenase (GCDH) gene. METHODS: Clinical data of the pair of twins and their parents were collected. Genomic DNA was extracted from peripheral blood samples, and variants of GCDH genes were detected by capture sequencing using a customized panel. Variants of the twins and their parents were verified by Sanger sequencing. RESULTS: The level of glutaric acyl carnitine (C5DC + C6OH) was 3.26 μmol/L in the male twin. The relative level of glutaric acid in urine was 547.51 by gas chromatography mass spectrometry analysis. Cerebral ultrasonography showed that the patient had subependymal hemorrhage, but no serious clinical manifestation was noted. After treating with special formula milk powder and L-carnitine, the boy showed good growth and development. Two heterozygous variants of the GCDH gene were detected in the patient, among which c.416C>G was suspected to be pathogenic, while c.109_110delCA was unreported. The variants were respectively inherited from his parents. The twin girl only carried the c.416C>G variant. CONCLUSION GA-I can be diagnosed by mass spectrometry, urine gas chromatographic mass spectrometry, imaging as well as genetic diagnosis. Early diagnosis and intervention is important.
Amino Acid Metabolism, Inborn Errors ; genetics ; Brain Diseases, Metabolic ; genetics ; Female ; Glutaryl-CoA Dehydrogenase ; deficiency ; genetics ; Humans ; Male ; Mutation ; Phenotype

Objective To investigate the influences of maternal gestational diabetes mellitus (GDM) on amino acid levels in neonates.Methods From June 2016 to May 2017,393 pregnancies diagnosed with GDM in Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University and 3 924 normal pregnancies were enrolled in this study.Clinical data of the gravidas and their newborns were collected.Heel blood samples were collected at 72 to 96 hours after birth.Tandem mass spectrometry was performed to detect the levels of 11 amino acids including alanine,arginine,citrulline,glycine,leucine/ isoleucine/hydroxyproline,methionine,ornithine,phenylalanine,proline,tyrosine and valine in neonatal heel blood.Differences in amino acid levels between the two groups were compared by t test.Influences of GDM on neonatal amino acid levels were analyzed by multivariate linear regression.Results Compared with the healthy pregnancy group,neonates in the GDM group had higher levels of methionine [(21.01 ±6.30) vs (19.93±6.47) μmol/L,t=3.159,P=0.002] and phenylalanine [(47.19±9.19) vs (45.78±8.58) μ mol/L,t=3.076,P=0.002],but lower levels of alanine [(280.51 ±64.54) vs (290.15±68.40) μ mol/L,t=2.678,P=0.007],proline [(147.64±30.64) vs (152.36±33.57) μ mol/L,t=2.680,P=0.007],tyrosine [(85.21 ±29.50) vs (90.60± 33.32) μ mol/L,t=3.089,P=0.002] and ornithine [(101.22±28.79) vs (105.83±30.10) μmol/L,t=2.906,P=0.004].Multivariate linear regression analysis showed that GDM was responsible for the increase of methionine (β=0.69,95％CI:0.02 to 1.37,P=0.044) and phenylalanine (β=1.60,95％CI:0.69 to 2.51,P=0.001),and the decrease of tyrosine (β=-4.98,95％CI:-8.42 to-1.54,P=0.005) and ornithine (β=-3.16,95％CI:-6.30 to-0.02,P=0.048) in neonates.Conclusions GDM neonates has increased of methionine and phenylalanine levels and decreased tyrosine and omithine levels.

Objective To investigate the effect of intensive follow-up on the correction of mild anemia among infants in the community. Methods Eighty four infants aged 6-12 months with mild anemia managed systematically in the child health clinic of Changzhou Lanling Community Health Service Center were enrolled from April 2016 to January 2017. Seventy five cases completed the study, including 36 cases managed with intensive follow-up (study group) and 39 cases managed with routine procedure (control group). The hemoglobin(Hb) levels, Hb changes, the rates of correction and closure of anemia and the medication of iron treatment were compared between two groups during the 2 and 6 month-follow-up. Results The Hb value, Hb changes, the rate of correction in study group were significantly higher than those in control group after 2 monthsof treatment [(113.50 ± 5.40)g/L vs. (109.13 ± 7.91)g/L, t=2.772, P=0.007;(13.22 ± 4.56)g/L vs. (7.54 ± 6.75)g/L, t=4.240, P<0.001;77.8％(28/36) vs. 46.2％(18/39),χ2=6.617, P=0.010, respectively]. In 6 month-follow-up, the Hb value, the rate of correction and closure rate in study group were significantly higher than those in control group [(116.22±3.72)g/L vs. (112.23±5.90)g/L, t=3.471, P=0.001;88.9％(32/36) vs. 66.7％(26/39),χ2=4.082, P=0.043;77.8％(28/36) vs. 41.0％(16/39),χ2=8.967, P=0.003, respectively]. For infants receiving iron treatment, the proportion of standardized medication in study group was significantly higher than that in control group after 2 months (14/14 vs. 4/8, χ2=5.525, P=0.019); the Hb values in study group were significantly higher than those in control group after 2 months[ (109.93 ± 3.51)g/L vs. (102.88 ± 2.88)g/L, t=4.820, P<0.001)and 6 months[(114.50±4.00)g/L vs. (108.55±5.04)g/L, t=3.297, P=0.003] of follow-up. Conclusion The intensive follow-up management can significantly improve the Hb values, the rates of correction and closure rate of infants with mild anemia in the community.

Objective To study the effects of family integrated care ( FIcare ) in the neonatal intensive care unit ( NICU) on preterm infants and their mothers′physical and mental health.Method From Jan 2016 to Dec 2016, preterm infants(birth weight 1000~2000 g;gestational age 26~34 weeks stabilized in NICU were randomly assigned into two groups:FIcare group and control group .The incidences of major diseases in infants , their mothers′depression score and anxiety score were studied .Result A total of 40 infants were assigned into two groups respectively .No significant differences existed between the two groups in gender , gestational age , brith weight , age, breastfeeding rate and their mothers′depression score and anxiety score (P>0.05).At discharge, the breastfeeding rate (90.0%vs.52.5%) and weight gain [(2258 ±112) g vs.(2105 ±103) g] of the FIcare group were significantly higher than the control group, and the hospital stay duration [(42.0 ±15.7) d vs.(43.5 ±14.3) d], hospitalization expenses [(40,000 ±18,000) RMB vs.(44,000 ±19,000) RMB], oxygen therapy duration [(10.4 ±5.7) d vs. (11.7 ±7.9) d], CPAP duration [(7.2 ±4.3) d vs.(8.1 ±5.0) d], mothers′depression score [(48.7 ±3.0) vs.(57.6 ±2.7)] and anxiety score [(49.4 ±1.1) vs.(61.1 ±1.9)]of the FIcare group were significantly lower than the control group ( P <0.05 ) . Conclusion Family-integrated care is beneficial for the recovery of preterm infants and their mother′s physical and mental health .

Objective Follow-up monitoring was carried out in infants infected with cytomegalovirus (CMV) so as to find out whether breastfeeding could bring about changes of CMV viral load.Methods Saliva of the neonates born in Changzhou Maternal and Child Health Hospital from Nov.2010 to Feb.2012,was collected for CMV screening.Premature infants,or the infants with seriously infectious diseases and deformities were excluded,such as severe intrauterine infection,congenital immune deficiency disease and so on.The full-term infants with aymptomatic infection were divided into the artificial feeding group and the breastfeeding group,and followed up for 6 months.During the 1st,the 3rd and the 6th month after their birth,their saliva and their mother's breast milk were collected.The method of realtime fluorescent quantitative PCR was adopted to test the changes in the viral load of CMV-DNA in the saliva and breast milk.Meanwhile,head B-ultrasound test,otoacoustic emission hearing screening,liver function test,blood routine analysis and so on were performed.Results Among infants from both artificial feeding group and breastfeeding group,during the 1 st,the 3 rd and the 6th month after birth,no significant changes in the DNA viral load of saliva and breast milk cytomegalovirus were found (t =2.832,3.161,3.475,all P ＞ 0.05).And in breastfeeding group,the cytomegalovirus DNA viral load in breast milk were 3.125 × 103 ±2.017 × 102 (the 1st month),2.688 × 103 ±2.251 × 102 (the 3rd month),3.016 × 103 ±2.613 × 102 (the 6th rmonth),also no significance during the time (F =1.725,P =0.667).Meanwhile,the head B-ultrasound,otoacoustic emission hearing screening,liver function test,blood routine analysis,etc showed no clinical significance (F =1.725,P =0.667).Conclusions In the CMV-infected neonates,even if CMV in breast milk is tested to be positive,breastfeeding can continue without causing secondary symptoms of infection.