Objective:To analyze the current status of red blood cell transfusion in very preterm infants (VPI) (gestational age at birth <32 weeks) from Chinese Neonatal Network (CHNN) in 2022.Methods:This cross-sectional study was based on the CHNN VPI cohort. It included 6 985 VPI admitted to CHNN 89 participating centers within 24 hours after birth in 2022. VPI with major congenital anomalies or those transferred to non-CHNN centers for treatment or discharged against medical advice were excluded. VPI were categorized based on whether they received red blood cell transfusions, their gestational age at birth, the type of respiratory support received during transfusion, and whether the pre-transfusion hemoglobin levels exceeded the thresholds. General characteristics, red blood cell transfusion rates, number of transfusions, timing of the first transfusion, and pre-transfusion hemoglobin levels were compared among different groups. The incidence of adverse outcomes between the group of VPI who received transfusions above the threshold and those who received transfusions below the threshold were compared. Comparison among different groups was conducted using χ2 tests, Kruskal-Wallis H tests, Mann-Whitney U test, and so on. Trends by gestational age at birth were evaluated by Cochran-Armitage tests and Jonckheere-Terpstra tests for trend. Results:Among the 6 985 VPI, 3 865 cases(55.3%) were male, with a gestational age at birth of 30.0 (28.6, 31.0) weeks and a birth weight of (1 302±321) g. Overall, 3 617 cases (51.8%) received red blood cell transfusion, while 3 368 cases (48.2%) did not. The red blood cell transfusion rate was 51.8% (3 617/6 985), with rates of 77.7% (893/1 150) for those born before 28 weeks gestational age and 46.7% (2 724/5 835) for those born between 28 and 31 weeks gestational age. A total of 9 616 times red blood cell transfusions were administered to 3 617 VPI, with 632 times missing pre-transfusion hemoglobin data, and 8 984 times included in the analysis. Of the red blood cell transfusions, 25.6% (2 459/9 616) were administered when invasive respiratory support was required, 51.3% (4 934/9 616) were receiving non-invasive respiratory support, while 23.1% (2 223/9, 616) were given when no respiratory support was needed. Compared to the non-transfusion group, the red blood cell transfusion group had a higher rate of pregnancy-induced hypertension in mothers, lower rates of born via cesarean section and mother′s antenatal steroid administration, smaller gestational age, lower birth weight, a higher proportion of small-for-gestational-age, multiple births, and proportions of Apgar score at the 5 th minute after birth ≤3 (all P<0.05). They were also less likely to be female, born in hospital or undergo delayed cord clamping (all P<0.01). Additionally, higher transport risk index of physiologic stability score at admission were observed in the red blood cell transfusion group ( P<0.001). The number of red blood cell transfusion was 2 (1, 3) times, with the first transfusion occurring at an age of 18 (8, 29) days, and a pre-transfusion hemoglobin level of 97 (86, 109) g/L. For VPI ≤7 days of age, the pre-transfusion hemoglobin levels for invasive respiratory support, non-invasive respiratory support, or no respiratory support, respectively, with no statistically significant differences between groups ( H=5.59, P=0.061). For VPI aged 8 to 21 days and≥22 days, the levels with statistically differences between groups (both P<0.01). Red blood cell transfusions above recommended thresholds were observed in all respiratory support categories at different stages of life, with the highest prevalence in infants aged 8 to 21 days and≥22 days who did not require respiratory support, at 90.1% (264/273) and 91.1%(1 578/1 732), respectively. The rate of necrotizing enterocolitis was higher in the above-threshold group ( χ2=10.59, P=0.001), and the duration of hospital stay was longer in the above-threshold group ( Z=4.67, P<0.001) compared to the below-threshold group. Conclusions:In 2022, the red blood cell transfusion rate was relatively high among VPI from CHNN. Pre-transfusion hemoglobin levels frequently exceeded recommended transfusion thresholds.

BACKGROUND: Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear. This study aimed to investigate associations of individual and combined lifestyle factors (LFs) with the incidence risk and long-term prognosis of pneumonia hospitalization. METHODS: Using data from the China Kadoorie Biobank study, we used the multistate models to investigate the role of five high-risk LFs, including smoking, excessive alcohol drinking, unhealthy dietary habits, physical inactivity, and unhealthy body shape, alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease (CVD, regarded as a reference outcome), and subsequently to mortality. RESULTS: Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death, but with different risk estimates. The greater the number of high-risk LFs, the higher the risk of developing pneumonia and long-term mortality risk after pneumonia, with the strength of associations comparable to that of LFs and CVD. Compared to participants with 0-1 high-risk LF, the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43 (1.28-1.60) and 1.98 (1.61-2.42), respectively. Correspondingly, the respective HRs (95% CIs) for transitions from baseline to CVD and from CVD to death were 2.00 (1.89-2.11) and 1.44 (1.30-1.59), respectively. The risk estimates changed slightly when further adjusting for the presence of major chronic diseases. CONCLUSION In this Chinese population, unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Cardiovascular Diseases/etiology* ; China/epidemiology* ; Life Style ; Pneumonia/etiology* ; Prognosis ; Risk Factors ; Smoking

Objective To compare the application effects of different anesthesia methods under preoper-ative optimization measures in elderly patients with hip fracture surgery.Methods A total of 120 elderly pa-tients (≥75 years old) with hip fracture surgery in this hospital from May 2022 to December 2023 were se-lected as the study subjects and divided into group A and group B,60 cases in each group.The two groups a-dopted the preoperative optimization measures.The group A performed "two single three low" (unilateral,once,low position,low concentration and low dose) lumbar anesthesia,while group B conducted the laryngeal mask artificial airway anesthesia.The hemodynamic changes at skin incision in operation beginning (T1),at 30 min after operation (T2),suture at operation end (T3),at the end of operation (T4) and at 30 min after opera-tion end (T5),postoperative recovery time and occurrence situation of complications such as nausea and vomi-ting,agitation,postoperative delirium (POD) were compared between the two groups.Results The systolic blood pressure and the heart rate at T1 in group B were lower than those in group A,and the differences were statistically significant (P<0.05).The systolic blood pressure and heart rate at T4 in group B were higher than those in group A,and the difference was statistically significant (P<0.05).The recovery time,agitation,nausea and vomiting and incidence rate of adverse reactions such as POD had no statistical difference between the two groups (P<0.05).Conclusion On the basis of preoperative optimization measures,selecting the "two single three low" lumbar anesthesia method in elderly patients with hip fracture surgery anesthesia has more stable hemodynamics,less complications and faster postoperative recovery.

Objective To investigate the effects of dexmedetomidine injection at the Neiguan acupoint before general anaesthesia on neurocognitive disorder and sleep quality after non-cardiac major surgery in eld-erly people.Methods Elderly patients undergoing elective thoracic and laparoscopic surgery in this hospital from February 2023 to March 2024 were selected and divided into the dexmedetomidine Neiguan acupoint in-jection group(A),saline Neiguan acupoint injection group(B)and dexmedetomidine intravenous injection group(C)by the randomised numerical table method,40 cases in each group.The postoperative neurocognitive function and sleep-related condition in the three groups were observed.Results The incidence rate of postop-erative delirium(POD)on postoperative 1 d in the group A and C was significantly decreased compared with the group B,and the difference was statistically significant(P＜0.05);the incidence rate of POD on postoper-ative 2 d in the group A was significantly decreased compared with the group B(P＜0.05);the incidence rate of postoperative cognitive dysfunction(POCD)on postoperative 1 d in the group A and C was significantly de-creased compared with the group B,moreover which in the group A was lower than that in the group C,and the differences were statistically significant(P＜0.05);the incidence rate of POCD on postoperative 3,5 d in the group A was lower than that in the group B(P＜0.05).The MMSE score on postoperative 1,3,5 d in the group B and C was significantly decreased compared with preoperative 1 d(P＜0.05).The MMSE score on postoperative 1,3,5 d in the group A and C was higher than that in the group B.and the difference was statis-tically significant(P＜0.05).The PSQI score on postoperative 1,3,5 d in the group A and C was increased compared with preoperative 1 d(P＜0.05);compared with the group B,the PSQI score on postoperative 1,3,5 d in the group A and C was decreased,moreover the group A was lower the group C,and the differences were statistically significant(P＜0.05).The incidence rate of bradycardia in the group A and C was signifi-cantly higher than that in the group B(P＜0.05).The incidence rate of postoperative nausea and vomiting(PONV)in the group A was significantly lower than that in the group B and C(P＜0.05),and the difference between the group B and C had no statistical significance(P＞0.05).Conclusion Dexmedetomidine injection at the Neiguan acupoint before anaesthesia for minimally invasive surgery can significantly reduce periopera-tive neurocognitive dysfunction(PND)and improve the quality of sleep in elderly patients,moreover simulta-neously has the effect for preventing PONV.

Accumulating evidence has confirmed the links between transfer RNA (tRNA) modifications and tumor progression. The present study is the first to explore the role of tRNA methyltransferase 5 (TRMT5), which catalyzes the m1G37 modification of mitochondrial tRNAs in hepatocellular carcinoma (HCC) progression. Here, based on bioinformatics and clinical analyses, we identified that TRMT5 expression was upregulated in HCC, which correlated with poor prognosis. Silencing TRMT5 attenuated HCC proliferation and metastasis both in vivo and in vitro, which may be partially explained by declined extracellular acidification rate (ECAR) and oxygen consumption rate (OCR). Mechanistically, we discovered that knockdown of TRMT5 inactivated the hypoxia-inducible factor-1 (HIF-1) signaling pathway by preventing HIF-1α stability through the enhancement of cellular oxygen content. Moreover, our data indicated that inhibition of TRMT5 sensitized HCC to doxorubicin by adjusting HIF-‍1α. In conclusion, our study revealed that targeting TRMT5 could inhibit HCC progression and increase the susceptibility of tumor cells to chemotherapy drugs. Thus, TRMT5 might be a carcinogenesis candidate gene that could serve as a potential target for HCC therapy.
Humans ; Carcinoma, Hepatocellular/pathology* ; Cell Hypoxia ; Cell Line, Tumor ; Gene Expression Regulation, Neoplastic ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism* ; Liver Neoplasms/pathology* ; Signal Transduction/genetics* ; tRNA Methyltransferases/metabolism*

Objective To explore the clinical characteristics and genetic mutation types of the Mediterranean anemia in Guangxi region in the early neonatal period.Methods The observation group was the children who hospitalized in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomons Region during the period of January 2013 and November 2015,and diagnosed Mediterranean anemia were 85 cases.And 85 newborns that were in the hospital at the same time were selected as the control group.The matching condition between the observation group and the control group was the gestational age.We retrospectively analyzed the general situation (birth weight and gender) and the treatment procedure (the characteristic of blood routine examinations;the day-old of the onset of anemia;the endurance of jaundice;assisted ventilation;the time of oxygen therapy;the dayold of enteral feeding;the blood transfusion times) of the two groups.And the gene was detected in the observation group.Results The observation group's days of life [(13.00 ± 3.79) d] of the oral feeding were higher than that [(9.33 ± 1.95) d] of the control group's (t =2.730,P ＜ 0.05);the observation group's frequency [(3.0 ± 1.0) times] of the blood transfusion was higher than that [(1.0 ± 0.2) times] of the control group's (t =4.268,P ＜ 0.05).The observation group's days of life [(4 ± 1) d] of anaemic onset was shorter than that [(8 ± 2) d] of the control group's (t =-3.258,P ＜ 0.05).The mean corpuscular volume [(80 ± 12) fl] in the blood routine of the observation group was smaller than that [(91 ± 28) fl] of the control group (t =6.712,P ＜ 0.05).In the observation group,the mother's age of pregnancy was (29.19 ± 0.91) years,the birth weight of the newborns was (2.356 ± 0.748) kg,the service time of the ventilator was (7.11 ± 5.07) h,the time of continue positive airway pressure was (27.40 ± 15.17) h,the time of the oxygen provision was (84.98 ± 30.65) h,the time of duration of the jaundice last was (10 ± 3) d;and in the control group,the mother's age of pregnancy was (27.9i ± 0.88) years,the birth weight of the newborns was (2.507 ± 0.783) kg,the service time of the ventilator was (6.21 ± 2.55) h,the time of continue positive airway pressure was (9.64 ± 4.89) h,the time of the oxygen provision was(63.07 ± 21.87) h,the time of duration of the jaundice last was (15 ± 2) d.The parameters showed above were not statistically different between the two groups (all P ＞ 0.05).In 85 cases the detection of α-thalassemia in 60 cases,24 patients with β-thalassemia,1 cases of α-thalassemia combined with β-thalassemia.The logistic regression analysis showed that the age of the oral feeding completely (OR =0.233,95％ CI =0.081-0.673) and the times of blood transfusion (OR =6.621,95％ CI =2.777-15.784) were the independence factors of the Mediterranean anemia.Conclusion The early clinical performance of Mediterranean anemia is lack of specificity,and we must improve genetic testing and regulate blood transfusion as soon as possible to the one who has anemia and other clinical manifestations within a week immediately following birth or who is suspected of Mediterranean anemia patients by the blood routine examination.

[Objective] Analyze the discussion of Qi and Qi transformation in Huangdi Neijing, therefore to give insight into the Qi Theory of TCM. [Methods] Analyze articles about Qi and Qi transformation in Huangdi Neijing, as well as comments from doctors of all dynasties, to summerize the understanding on Qi and Qi transformation of Huangdi Neijin. [Result] In the whole book of Huangdi Neijing, there are 19 chapters named after Qi, 1700 (2997) characters of Qi are mentioned, and there are 7 discussions upon Qi transformation. The Qi mentioned in Huangdi Neijing can be material, or functional, or be able to transform. The conception of Qi transformation includes six parts: the transformation among Yin and Yang, among the five elements, and the growth and transformation among all kinds of essences, the transportation, nutrition and transformation among all kinds of matters, as well as the transportation of Qi and the transformation of five elements' motion and six kinds of natural factors.[Conclusion] Qi transformation is mentioned in all but a few chapters in Huangdi Neijing. Everything, from matters growing to turning into essences is actually Qi transformation. In Huangdi Neijing's view, Qi transformation is the fundamental of all matters coming into being, and the fundamental to stay healthy, therefore the fundamental of preserving health, diagnosis and treatment.

Objective To study the clinical characteristics and imaging features of perinatal autosomal recessive polycystic kidney disease ( ARPKD) and a systematic review of the literature was performed to improve awareness of the disease. Methods A newborn with infantile ARPKD admitted to the neonatal department of our hospital was studied and her clinical data and imaging features retrospectively reviewed. CNKI, CBMdisc, MEDLINE and Embase databases were searched using autosomal recessive, perinatal and polycystic kidney as keywords. 9 case reports were retrieved from 2005 to 2015 and a total of 9 patients were analyzed. Results The gestational age of patients with infantile ARPKD was from 33 to 37 weeks. 6 of them were diagnosed using prenatal ultrasound and one patient was diagnosed using genetic sequencing. One of 10 infants had a family history, 4 patientsˊ mothers had abnormal pregnancy history (spontaneous abortion or miscarriage) and 7 (70. 0%) patients with respiratory failure needed mechanical ventilation. The ultrasound of all the patients showed enlarged and hyperechogenic kidneys. 9 patients died, and only one patient was alive after renal transplant. Conclusions The characteristics of perinatal APRKD are enlarged and polycystic kidneys, hepatic cysts and liver fibrosis. Infants with this disease have poor outcomes and high mortality rate. Respiratory failure and renal failure are the main causes of death in the neonatal period and early diagnosis and treatment are necessary.

Objective To investigate the differential diagnostic value of 18 F‐DG PET/CT imaging on gastric malignancies and primary gastric lymphoma(PGL) .Methods A total of 93 cases of gastric cancer (23 cases of mucinous adenocarcinoma and 70 ca‐ses of non mucinous adenocarcinoma ) ,58 cases of PGL and 31 cases of Diffuse Large b Cell Lymphoma (DLBCL ) and 27 cases of Mucosa associated tissue lymphoma (MALT) treated in our hospital from Jun 2012 to Jun 2015 were involved in this study .Their clinical data ,SUVmax ,maximum lesions thickness ,CT value ,lesion shape ,merge splenomegaly and lymph node metastasis were compared .The relation between SUVmax and maximum lesions thickness were analyzed with Pearson analysis .Results The aver‐age age and the lesions involve cardiac orifice rate of the gastric cancer group were significantly higher than that of PGL group (P<0 .05) .The occurence rate of SUVmax and splenomegaly in the gastric cancer group were significantly lower than that of PGL group (P<0 .05) .From the perspective of lesion shape ,type Ⅱand Ⅲ were mostly found in gastric cancer group ,while type ⅠandⅡwere mostly seen in PGL group ,the difference was significant(P<0 .05) .Further analysis showed that the SUVmax of DLBCL was significantly higher than other type(P<0 .05);the maximum lesions thickness of DLBCL was significantly higher than gastric mucous adenocarcinoma and MALT (P<0 .05) .Pearson analysis showed that there was no significant difference between SUVmax of different pathological type and the maximum lesions thickness (P>0 .05) .Conclusion The diagnostic value of 18 F‐FDG PET/CT in gastric malignancies was high ,and patients with different cancer and pathological type were different in SUVmax ,maximum le‐sions thickness and lesion shape .

Objective] The article analyzed the application of qi transformation for diagnosis and treatment in clinic from four aspects: theory, method, formula and herbs. [Methods] Wang Kungen is instructor of the fourth,fifth project of academic experience inheriting the old Chinese medicine experts. Director Wang believes that the Qi transformation is the fundamental of everythings,including the humanbody.To analyze the relationship between qi transformation and theory-method-formula-herbs in clinical TCM based on the study of Huangdi Neijing and textual works of famous Chinese physicians. [Result]Qi transformation is the foundation of life, therefore the foundation of health. Abnormal Qi transformation leads to process and development of diseases, so the key to the treatment is to achieve the condition of“seizing the mechanism of disease and keeping qi in harmony”through all methods, rather than holding on to specific treatments like acupuncture and herbs. [Conclusion]Qi transformation is not only an important content of TCM theory system, but also the key point of treatment in clinic, and the core clinical theory of Director Wang.