Objective: To explore the relationship between serum homocysteine (Hcy), interleukin-5 (IL-5), folate and core symptoms in children with autism spectrum disorders, so as to provide potential biomarkers for early diagnosis and intervention of diseases. Methods: A total of 106 children with autism spectrum disorders and 106 healthy children with matched sex and age in Lu an People s Hospital were enrolled as autism group and healthy group between May 2020 to December 2023. On the day of admission, levels of serum Hcy, IL-5 and folate were detected. The core symptoms in autism group were evaluated by Autism Behavior Checklist (ABC), Wechsler Preschool and Primary Scale of Intelligence-fourth edition(WPPSI-IV), Childhood Autism Rating Scale (CARS) and Social Responsiveness Scale (SRS). The levels of serum Hcy, IL-5 and folate in the two groups were compared by t- test. The relationship between serum Hcy, IL-5, folate and core symptoms in children with autism spectrum disorders was determined by Pearson correlation analysis. Results: The levels of serum Hcy and IL-5 in autism group were (7.48±0.32) μmol/L and (345.77±32.51) pg/mL, higher than those in healthy group [(6.11±0.54) μmol/L, (274.04±25.17) pg/mL], while folate level was lower than that in healthy group [(15.24±3.47) ng/mL, (22.51±4.69) ng/mL], the differences were statistically significant ( t =22.47, 17.96, 12.83, all P < 0.05 ). In autism group, levels of serum Hcy and IL-5 were positively correlated with scores of ABC, CARS and SRS ( r =0.29, 0.53 , 0.54; 0.45, 0.41, 0.50), while negatively correlated with WPPSI-IV score ( r =-0.28, -0.26)(all P <0.05). The folate level was negatively correlated with scores of ABC, CARS and SRS ( r =-0.55, -0.40, -0.25), while positively correlated with WPPSI-IV score ( r =0.41) (all P <0.05). Conclusion Children with ASD show elevated serum Hcy and IL-5 alongside decreased folate,and three markers correlate with core symptoms and intellectual level.

Objective To understand the antibody levels of diphtheria and tetanus among healthy population in Shanghai Pudong New Area, and to provide a scientific basis for improving the vaccine immunization strategy. Methods Random sampling was used to select healthy people of all ages in 16 communities in Shanghai Pudong New Area from 2018 to 2024, and serum samples were collected and tested for serum anti-diphtheria and tetanus toxin IgG antibodies by enzyme-linked immunosorbent assay (ELISA) method to analyze the antibody positivity rate (≥0.1 IU/ml) and the geometric mean concentration (GMC) of antibodies. Results A total of 3 312 serum samples were included, with a male-to-female ratio of 0.76:1, and 53.77% were local residents. The seropositivity rates and geometric mean concentrations (GMC) of both diphtheria and tetanus antibodies generally declined with increasing age, but exhibited a transient rebound in the 7y-. A total of 1 175 individuals (35.48%) were seropositive for diphtheria, with a GMC of 0.054 IU/mL. For tetanus, 988 individuals (29.83%) were seropositive, with a GMC of 0.033 IU/mL. Significant differences in seropositivity rates (χ²_diphtheria=950.005,χ²_tetanus=1 324.393) and GMC (H_diphtheria=1027.160,H_tetanus=1 142.007) were observed among different age groups (P<0.001). Significant differences in seropositivity rates (χ²_diphtheria=950.005,χ²_tetanus=1324.393) and GMC (H_diphtheria=1027.160,H_tetanus=1142.007) were also found across different years (P<0.001). Conclusion The prevalence of diphtheria and tetanus antibodies in the healthy population of Pudong New Area is relatively low, particularly among adults over 20 years of age with inadequate immunization. This underscores the need to reinforce the National Immunization Program (NIP) vaccine specifications for children under 6 years of age and implement an immunization strategy for adolescents or adults against diphtheria and tetanus.

Objective To explore the characteristics and correlation between perivascular spaces (PVS) and diffusion tensor image analysis along perivascular spaces (DTI-ALPS) index in patients with amnestic mild cognitive impairment (aMCI). Methods A retrospective study was conducted on a total of 118 participants, including cognitive normal (CN) healthy controls and aMCI patients, recruited from the Department of Neurology, Zhongshan Hospital, Fudan University from September 2020 to September 2022. All participants underwent structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). An automatic segmentation algorithm was used to quantify PVS metrics in the brain, and DTI-ALPS index was calculated based on DTI. Differences in DTI-ALPS index and PVS metrics between the CN and aMCI groups were compared. Multivariate logistic regression was used to identify independent factors influencing aMCI. Correlation analysis was performed to assess relationships among DTI-ALPS index, PVS metrics, and cognitive scores. Results A total of 80 CN healthy controls and 38 aMCI patients were included. The DTI-ALPS index was significantly lower in the aMCI group compared with the CN group (1.28±0.18 vs 1.37±0.21, P＝0.018), while differences in PVS metrics between groups were not statistically significant. Multivariate logistic regression analysis indicated that DTI-ALPS index was an independent factor affecting aMCI (OR＝0.097, 95%CI 0.011–0.833, P＝0.033). Correlation analysis revealed a positive relationship between DTI-ALPS index and MMSE score (r＝0.210, P＝0.023) as well as PVS length in the centrum semiovale (r＝0.216, P＝0.019). Conclusions The DTI-ALPS index may serve as an imaging biomarker for identifying early cognitive impairment, and patients with aMCI exhibit abnormal DTI-ALPS indices, suggesting that brain glymphatic system dysfunction may occur prior to morphological changes.

Objective To evaluate the effect of remimazolam premedication on emergence delirium （ED） in children undergoing tonsillectomy and/or adenoidectomy. Methods Children aged 3-6 years who underwent tonsillectomy and/or adenoidectomy with general anesthesia in Zhongshan Hospital Affiliated to Xiamen University from July 2023 to September 2024 were randomly divided into 0.1 mg/kg remimazolam group （group R1）, 0.2 mg/kg remimazolam group group R2） and normal saline group （group P）. Three groups were sedated preoperatively with remimazolam 0.1 mg/kg, remimazolam 0.2 mg/kg and normal saline, respectively. The primary outcome was the incidence of ED. The secondary outcomes included the parental separation anxiety scale （PSAS） score when entering the operating room, the induction compliance checklist （ICC） score at induction, the anesthetic recovery time, the incidence of rescue propofol for ED, the face, legs, activity, cry, and consolability （FLACC） score and the incidence of postoperative pain during the recovery period, the incidence of adverse reactions during the operation and postoperatively, and the incidence of negative postoperative behavioral changes （NPOBCs） at first day, 7th day, 30th day postoperatively. Results A total of 119 children completed the study, including 41 children in group R1, 38 children in group R2, and 40 children ingroup P. The incidence of ED and propofol rescue, the PSAS scores and ICC scores of group R1 and R2 were lower than that of group P （P<0.05）, and the above results in group R2 was better than those in group R1 （P<0.05）. The FLACC score, the incidence of postoperative pain, and the incidence of adverse reactions among the three groups had no difference （P>0.05）. The incidence of NPOBCs at 1st day and 7th day postoperatively in group R1 and group R2 was lower than that in group P （P<0.05）, but no difference was detected at 30th day postoperatively among the three groups （P>0.05）. Conclusion Remimazolam used for preoperative sedation could reduce the incidence of ED in children undergoing tonsillectomy and/or adenoidectomy, and had a positive effect on alleviating the preoperative anxiety and preventing NPOBCs.

Objective To evaluate the advantages of powder-liquid double-chamber bag products compared with traditional powder injection. Methods The systematic review method was used to collect the literature on powder-liquid double-chamber bag, extract common evaluation indicators, evaluate the use value of powder-liquid double-chamber bag products, and conduct a comprehensive comparison with traditional powder injection products. Results A total of 23 articles were included in the literature. The effectiveness indicators used for evaluation were the stability of the liquid medicine, the accuracy of the preparation concentration, and the residual amount of the liquid medicine; the safety indicators were the incidence of insoluble particles and the incidence of punctures and scratches. The economic indicators were preparation cost, occupied volume of preparation supplies, waste weight, hospitalization cost and incidence of blood infection. The applicability indicators were preparation time, average occupation of medical staff, packaging weight and storage and transportation volume, environmental adaptability, and ease of waste disposal. Accessibility indicators are the number of manufacturers, raw material supply capacity, and patient affordability. Through the evaluation of literature evidence, it was found that the stability and concentration accuracy of the powder-liquid double-chamber bag were higher than those of the traditional powder injection, and the domestic supply had been achieved. The double-chamber bag method can reduce the infusion reaction and shorten the preparation time of the liquid medicine. Conclusion Compared with traditional powder injectabler products, powder-liquid double-chamber bags have advantages in the dimensions of effectiveness, safety, economy, suitability and innovation, and the accessibility dimension meets the requirements.

OBJECTIVES: Prolonged invasive mechanical ventilation is associated with increased risks of severe complications such as retinopathy of prematurity and bronchopulmonary dysplasia. Although neonatal intensive care unit (NICU) follow the principle of early extubation, extubation failure rates remain high, and reintubation may further increase the risk of adverse outcomes. This study aims to identify risk factors and short-term prognosis associated with first extubation failure in neonates, to provide evidence for effective clinical intervention strategies. METHODS: Clinical data of neonates who received invasive ventilation in the NICU of Children's Hospital of Nanjing Medical University from January 1, 2019, to December 31, 2021, were retrospectively collected. Neonates were divided into a successful extubation group and a failed extubation group based on whether reintubation occurred within 72 hours after the first extubation. Risk factors and short-term outcomes related to extubation failure were analyzed. RESULTS: A total of 337 infants were included, with 218 males (64.69%). Initial extubation failed in 34 (10.09%) infants. Compared with the successful extubation group, the failed extubation group had significantly lower gestational age [(31.37±5.14) weeks vs (34.44±4.07) weeks], age [2.5 (1.00, 8.25) h vs 5 (1.00, 22.00) h], birth weight [(1 818.97±1128.80) g vs (2 432.18±928.94) g], 1-minute Apgar score (6.91±1.90 vs 7.68±2.03), and the proportion of using mask oxygenation after extubation (21% vs 46%) (all P<0.05). Conversely, compared with the successful extubation group, the failed extubation group had significantly higher rates of vaginal delivery (59% vs 32%), caffeine use during mechanical ventilation (71% vs 38%), dexamethasone use at extubation (44% vs 17%), the highest positive end-expiratory pressure level within 72 hours post-extubation [6(5.00, 6.00) cmH₂O vs 5 (0.00, 6.00) cmH₂O] (1 cmH₂O=0.098 kPa), the highest FiO₂ within 72 hours post-extubation [(34.35±5.95)% vs (30.22±3.58)%], and duration of noninvasive intermittent positive pressure ventilation after extubation [0.5 (0.00, 42.00) hours vs 0 (0, 0) hours] (all P<0.05). Multivariate analysis identified gestational age <28 weeks (OR=5.570, 95% CI 1.866 to 16.430), age at NICU admission (OR=0.959, 95% CI 0.918 to 0.989), and a maximum FiO₂≥35% within 72 hours post-extubation (OR=4.541, 95% CI 1.849 to 10.980) as independent risk factors for extubation failure (all P<0.05). Additionally, the failed extubation group exhibited significantly higher incidences of necrotizing enterocolitis grade II or above, moderate-to-severe bronchopulmonary dysplasia, severe bronchopulmonary dysplasia, retinopathy of prematurity, treatment abandonment due to poor prognosis, and discharge on home oxygen therapy (all P<0.05). Total hospital length of stay and total hospitalization costs were also significantly increased in the failed extubation group (all P<0.05). CONCLUSIONS Gestational age <28 weeks, younger age at NICU admission, and FiO₂≥35% after extubation are high-risk factors for first extubation failure in neonates. Extubation failure markedly increases the risk of adverse clinical outcomes.
Humans ; Infant, Newborn ; Male ; Female ; Airway Extubation/adverse effects* ; Risk Factors ; Retrospective Studies ; Respiration, Artificial/methods* ; Intensive Care Units, Neonatal ; Prognosis ; Gestational Age ; Bronchopulmonary Dysplasia ; Infant, Premature ; Treatment Failure ; Intubation, Intratracheal

Objective To analyze the predictive value of the serum amyloid A/C-reactive protein ratio(SAA/CRP),lactate dehydrogenase(LDH),and chitinase-40(YKL-40)combined with conventional influencing factors for the prognosis of children with refractory mycoplasmal pneumonia(RMPP).Methods A retrospective study was conducted on 180 children with RMPP admitted to the First People's Hospital of Nanyang from January to December 2023,serving as study group,and 90 children with general mycoplasmal pneumonia(GMPP)as control group.The clinical data of the two groups,including age,gender,and serum levels of SAA/CRP,LDH,and YKL-40,were compared.On the day of admission,the disease severity of the children in study group was assessed and divided into mild(n=102)and severe(n=78)groups.After treatment,they were further categorized into poor prognosis(n=52)and good prognosis(n=128)groups based on the occurrence of adverse events.The levels of serum SAA/CRP,LDH,and YKL-40 were compared between mild-case and severe-case children in study group,as well as between children with good and poor prognosis.A binary logistic regression model was used to analyze the influencing factors for poor prognosis in children with RMPP.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum SAA/CRP,LDH,and YKL-40 for the prognosis of children with RMPP.Conventional influencing factors[disease severity,oxygen therapy duration,pneumonia severity index(PSI)score,and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score]were used as the conventional prediction scheme,and the conventional prediction scheme combined with the levels of serum SAA/CRP,LDH,and YKL-40 was used as the new prediction scheme.The predictive values of the two prediction schemes for the prognosis of children with RMPP were compared.Results The levels of serum SAA/CRP,LDH,and YKL-40 in study group were higher than those in control group(P＜0.05),and the levels of serum SAA/CRP,LDH,and YKL-40 in children with severe RMPP were higher than those in children with mild RMPP(P＜0.05).In study group,the proportion of children with pleural effusion,the proportion of severe-case disease severity,oxygen therapy duration,PSI score,APACHE Ⅱ score,and the levels of serum SAA/CRP,LDH,and YKL-40 in children with poor prognosis were higher than those in children with good prognosis(P＜0.05).Binary logistic regression analysis showed that disease severity,oxygen therapy duration,PSI score,APACHE Ⅱ score,and the levels of serum SAA/CRP,LDH,and YKL-40 were all factors affecting poor prognosis in children with RMPP(P＜0.05).The areas under the curves(AUCs)of serum SAA/CRP,LDH,and YKL-40 for predicting the prognosis of children with RMPP were 0.756,0.749,and 0.734,respectively.The AUC of the new prediction scheme was 0.945,which was significantly higher than that of the conventional prediction scheme(AUC=0.859),with a statistically significant difference(P=0.011).Conclusion Serum SAA/CRP,LDH,and YKL-40 levels combined with the conventional prediction scheme have a high predictive efficacy for the prognosis of children with RMPP.