OBJECTIVE To investigate the effects of different sterilization methods on 3D-printed polylactic acid(PLA)guide plates for orthopedic surgery,and to analyze their physical properties,microbial contamination,structural performance and bio compatibility after sterilization.METHODS PLA guide plates for orthopedic surgery were prepared with 3D printing technology and divided into a blank group,a hydrogen peroxide plasma steriliza-tion group,an ethylene oxide sterilization group and a pressure steam sterilization group.Before and after sterili-zation,the changes in volume and weight of the surgical guide plates were measured,microbial detection was con-ducted,structural changes were observed with a laser scanning confocal microscope,and cell co-culture was con-ducted to evaluate biocompatibility,thereby the effects of different sterilization methods were assessed.RESULTS The three sterilization methods had no significant effect on the volume and weight of PLA surgical guide plates.Microbial detection showed that all three sterilization methods were effective in killing bacteria,and bacte-rial cultures were negative.Laser confocal scanning microscopy revealed that sterilization treatment caused certain changes to the microstructure of the surgical guide plates,but high-temperature sterilization had a more pro-nounced effect on the deformation of the guide plate edges.Cell co-culture results indicated that the surgical guide plates treated with the three sterilization methods exhibited acceptable cytotoxicity and had little effect on cell pro-liferation.CONCLUSIONS All three sterilization methods cause microstructural changes to the surgical guide plate.Among them,pressure steam sterilization significantly deforms the structure of the guide plate,directly af-fecting its precise positioning of mutual spatial distances,angular relationships and orientation during surgery.Al-though hydrogen peroxide plasma sterilization does not cause significant deformation,ethylene oxide sterilization has the least impact on material properties and structural stability while ensuring the sterilization effect of PLA surgical guide plates.

OBJECTIVE To investigate the effects of different sterilization methods on 3D-printed polylactic acid(PLA)guide plates for orthopedic surgery,and to analyze their physical properties,microbial contamination,structural performance and bio compatibility after sterilization.METHODS PLA guide plates for orthopedic surgery were prepared with 3D printing technology and divided into a blank group,a hydrogen peroxide plasma steriliza-tion group,an ethylene oxide sterilization group and a pressure steam sterilization group.Before and after sterili-zation,the changes in volume and weight of the surgical guide plates were measured,microbial detection was con-ducted,structural changes were observed with a laser scanning confocal microscope,and cell co-culture was con-ducted to evaluate biocompatibility,thereby the effects of different sterilization methods were assessed.RESULTS The three sterilization methods had no significant effect on the volume and weight of PLA surgical guide plates.Microbial detection showed that all three sterilization methods were effective in killing bacteria,and bacte-rial cultures were negative.Laser confocal scanning microscopy revealed that sterilization treatment caused certain changes to the microstructure of the surgical guide plates,but high-temperature sterilization had a more pro-nounced effect on the deformation of the guide plate edges.Cell co-culture results indicated that the surgical guide plates treated with the three sterilization methods exhibited acceptable cytotoxicity and had little effect on cell pro-liferation.CONCLUSIONS All three sterilization methods cause microstructural changes to the surgical guide plate.Among them,pressure steam sterilization significantly deforms the structure of the guide plate,directly af-fecting its precise positioning of mutual spatial distances,angular relationships and orientation during surgery.Al-though hydrogen peroxide plasma sterilization does not cause significant deformation,ethylene oxide sterilization has the least impact on material properties and structural stability while ensuring the sterilization effect of PLA surgical guide plates.

Objective:To analyze the clinical features and follow-up data in children with neuropsychiatric lupus erythematosus (NPSLE), and provide reference for the diagnosis and treatment of NPSLE.Methods:The clinical data of 22 children with NPSLE who were admitted to the Department of Rheumatology Immunology and Allergy, Children′s Hospital of Zhejiang University School of Medicine from January 2019 to March 2022 were included and were followed-up for 24~60 months. The data were analyzed retrospectively. Statistical descriptive analysis was performed using the SPSS 23.0.Results:Twenty-two (26.8%, 22/82) children with NPSLE occurred in the hospitalized children with SLE during the study period. The ratio of male to female was 1∶4.5, and the onset age was (10.7±2.0) years. Among these cases, 86.4% (19/22) patients were newly diagnosed and had severe disease activity and 16 cases (72.7%) occurred within 1 month after disease onset. Nineteen cases (86.4%) had mucocutaneous involvement, 16 cases (72.7%) had lupus nephritis, 14 cases (63.2%) had hematological system involvement, 13 cases (59.1%) had skeletal muscle involvement, 10 cases (45.5%) had serositis, 10 cases (45.5%) were complicated with hypertension, and 8 cases (36.5%) with macrophage activation syndrome (MAS). The main clinical symptoms of the nervous system included headache (11/19, 57.9%), dizziness (10/19, 52.6%), listlessness (7/19, 36.8%), blurred vision (4/19, 21.1%), convulsions (3/19, 15.8%), lethargy (2/19, 10.5%). Twenty patients (20/22, 90.9%) demonstrated abnormal signals on brain MRI, 7 cases (7/12, 45.5%) showed abnormal signals on brain CT, 10 cases (10/22, 45.5%) showed abnormal waves on EEG, and 6 cases (6/20, 30.0%) demonstrated abnormal results of cerebrospinal fluids analysis. The follow-up duration was 34 (28, 48) months. Clinical remission or low disease activity was found in 19 patients (86.4%), and no death were observed. Three cases had residual cerebral infarction lesions, no neurological sequelae were found in all patients.Conclusion:The most common symptoms of NPSLE in children are headache and dizziness, which are more likely to occur in patients with initial onset and severe disease activity, and approximately 36.5% children with NPSLE may complicated by MAS.The results of 24-60 months follow-up showed that the prognosis of the disease is good.

ObjectiveTo explore the recognition of oral breath odor map of chronic atrophic gastritis （CAG） patients with dampness-heat syndrome by electronic nose technique. MethodsPatients with chronic gastritis were recruited， including 60 cases in CAG group of dampness-heat syndrome， 50 cases in CAG group of non-dampness-heat syndrome， 60 cases in chronic non-atrophic gastritis （CNAG） group of dampness-heat syndrome， 50 cases in CNAG group of non-dampness-heat syndrome， and 30 cases of healthy volunteers were selected to set up the health control group. Ten cases in the CAG dampness-heat group and 50 cases in the CAG non-dampness-heat group were selected to form the CAG group， and 10 cases in CNAG dampness-heat group and 50 cases in CNAG non-dampness-heat group were selected to form the CNAG group. In addition to the health control group， the remaining patients were tested for Helicobacter pylori （Hp）； the electronic nose （GISXM-MQWA01） was used to collect the oral breath odor of all the participants to draw the mapping， and amplitudes and slopes of each curve （including curves A， B， C， D， E， F， G， H， I， J） of the oral odor mapping of health control group， CAG group， CNAG group， CAG dampness-heat group， CAG non-dampness-heat group， and CNAG dampness-heat group was compared. The modified transformer model was used to classify the odor mapping characteristics， and the confusion matrix method was used to evaluate the classification model， with metrics including accuracy and area under ROC curve （AUC）. ResultsThe Hp positivity rate in CAG dampness-heat group was 80.00% （48/60）， CAG non-dampness-heat group was 62.00% （31/50）， CNAG dampness-heat group was 46.67% （28/60）， and CNAG non-dampness-heat group was 42.00% （21/50）； the difference in Hp positivity rate between CAG dampness-heat group and CAG non-dampness-heat group was statistically significant （P＜0.05）. The amplitudes of response curves A， B， C， D， F， G， and I， and slopes of A and F in the odor mapping of the CAG group were lower than those in health control group， while the amplitude and slope of curve E were higher than those in the health control group and CNAG group （P＜0.05 or P＜0.01）； The amplitude of the response curves A， B， C， D， F， G， and I， and slopes of A， D， and F in the CNAG group were lower than those in the health control group （P＜0.05 or P＜0.01）. The amplitude of response curve D and slope of response curve J in the odor mapping of the CAG dampness-heat group were higher than those in CNAG dampness-heat group， the amplitude of curve F was lower than that in CAG non-dampness-heat group， and the amplitude of curve H and slopes of curve A， H， and J were higher than those in CAG non-dampness-heat group （P＜0.05）. The recognition accuracy of CAG group and health control group reached 77.78%， AUC = 0.88； the recognition accuracy of CAG group and CNAG group was 69.44%， AUC = 0.61； the recognition accuracy of CAG dampness-heat group and CAG non-dampness-heat group reached 75.8%， AUC=0.70. ConclusionElectronic nose technology can make a more accurate identification of the oral breath odor in CAG patients with dampness-heat syndrome， with a decrease in the amplitude of the curve F and an increase in the amplitude of the curve H and in the slopes of the curves A， H， and J may as the characteristics of their odor mapping.

Objective:To explore the value of intermittent photic stimulation (IPS) in children′s video electroencephalography (EEG).Methods:The data of 8 994 children aged 1 to 18 years, who received IPS in the video EEG examination at the Liangjiang Campus of the Children′s Hospital of Chongqing Medical University from March 2021 to March 2022, were analyzed retrospectively.Patients were divided into non-epilepsy group and confirmed or suspected epilepsy group.Their IPS responses, clinical and EEG characteristics were collected.Categorical variables were expressed using frequencies and percentages.The relationship between IPS response and age was determined by Chi- square test or Fisher′ s exact probability method. Results:The median age of 8 994 children was 6.3 years.There were 2 310 (25.7%) children in the non-epileptic group, including 1 364 (59.0%) males and 946 (41.0%) females.There were 6 684 (74.3%) children in the confirmed or suspected epileptic group, including 3 842 (57.5%) males and 2 842 (42.5%) females.In the non-epileptic group, 141 cases (6.1%) had IPS photo-driving responses, and 1 case had photo paroxysmal response (PPR). In the confirmed or suspected epilepsy group, IPS photo-driving responses (2.4%) occurred in 160 cases, PPR (1.2%) in 82 cases, photo convulsion responses(0.3%) in 18 cases, and asymmetric photo-driving responses (0.2%) in 14 cases.The IPS photosensitivity responses varied among children of different ages, sexes, epileptic discharge types and seizure types in the confirmed or suspected epilepsy group.The children aged 6 to 18 years showed significantly stronger photosensitivity responses than those aged 1 to <6 years ( P<0.001). The photosensitivity activity in females was 1.9 times higher than that in males.The photosensitivity activity in patients with generalized discharges was 1.7 times more intense than that in patients with focal discharges.The photosensitivity reaction in patients with photo convulsive generalized seizures was 2.5 times stronger than that in patients with focal seizures. Conclusions:Routine standardized IPS is important for the detection of photosensitivity in children diagnosed or suspected with epilepsy.It can effectively guide the medical practice.

Objective:To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section.Methods:A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. The risk factors of intraoperative blood loss ≥1 500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results:(1) A total of 848 001 ml of blood was recovered and a total of 418 649 ml of blood was transfused in 1 265 pregnant women who received IOCS transfusions, which was equivalent to 23 258 U red blood cell suspension, greatly saving medical resources. The intraoperative blood loss in <1 500 ml group and ≥1 500 ml group was 800 ml (300-1 453 ml) and 2 335 ml (1 500-20 000 ml), respectively. No amniotic fluid embolism, severe adverse reactions, shock and death occurred in the two groups. (3) Multivariate regression analysis showed that age ≥35 years ( OR=1.5, 95% CI: 1.1-1.9), prenatal hemoglobin level <110 g/L ( OR=1.7, 95% CI: 1.3-2.2), history of uterine surgery ( OR=1.8, 95% CI: 1.3-2.6), placenta previa ( OR=1.9, 95% CI: 1.1-3.1), placenta accreta ( OR=2.6, 95% CI: 1.8-3.9), blood pool in the placenta ( OR=1.6, 95% CI: 1.1-2.3), abnormal posterior placenta muscle wall ( OR=1.8, 95% CI: 1.2-2.6), placenta projecting to the anterior uterine wall ( OR=3.0, 95% CI: 1.3-7.0) were risk factors for blood loss ≥1 500 ml in obstetric transfusion using IOCS technique, with statistical significance (all P<0.05). Conclusion:IOCS is safe and effective in cesarean section, which could save the medical resources and reduces medical expenses, however, it is necessary to strictly master the application indication.

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is the main cause of chronic hepatitis B. The prevention of MTCT plays a critical role in control chronic hepatitis B. The main purpose of the present clinical guidelines is to aid healthcare providers in managing pregnant women with positive HBsAg and in preventing MTCT of HBV. We recommend: (1) all pregnant women require prenatal screen for hepatitis B serological markers; (2) newborn infants of mothers with negative hepatitis B surface (HBsAg) require administration of hepatitis B vaccine on a 0, 1, and 6 month-schedule; (3) newborn infants of mothers with positive HBsAg need hepatitis B immunoglobulin (HBIG) and birth dose vaccine within 12 hours (the sooner the better) after birth, followed by injection of the second and third dose of hepatitis B vaccine at the age of one and six months respectively; (4) in preterm neonates or neonates with poor health conditions born to HBsAg-positive mothers, the immunoprophylaxis measures should be appropriately taken; (5) to further reduce MTCT of HBV, pregnant women with HBV DNA levels >2×10 5 IU/mL or positive hepatitis B e antigen may receive oral antivirals, starting from 28 to 32 weeks of gestation and discontinuing the drug on the delivery day; (6) cesarean section is not recommended to reduce MTCT of HBV; (7) breastfeeding is recommended in infants of HBsAg-positive mothers, regardless of maternally positive hepatitis B e antigen, maternal nipple injury or bleeding, oral mucosal injury in neonates or infants; (8) breastfeeding is recommended in infants born to HBsAg-positive mothers who require continuation of antiviral therapy after delivery, and the infants should be followed up to observe whether adverse effects develop; and (9) the infants born to HBsAg-positive mothers should be tested for hepatitis B serological markers at the age of 7-12 months, and those who are negative for HBsAg and anti-HBs should receive three doses of hepatitis B vaccine on the 0, 1, and 6 month-schedule as soon as possible.

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is the main cause of chronic hepatitis B. The prevention of MTCT plays a critical role in control chronic hepatitis B. The main purpose of the present clinical guidelines is to aid healthcare providers in managing pregnant women with positive HBsAg and in preventing MTCT of HBV. We recommend: (1) all pregnant women require prenatal screen for hepatitis B serological markers; (2) newborn infants of mothers with negative hepatitis B surface (HBsAg) require administration of hepatitis B vaccine on a 0, 1, and 6 month-schedule; (3) newborn infants of mothers with positive HBsAg need hepatitis B immunoglobulin (HBIG) and birth dose vaccine within 12 hours (the sooner the better) after birth, followed by injection of the second and third dose of hepatitis B vaccine at the age of one and six months respectively; (4) in preterm neonates or neonates with poor health conditions born to HBsAg-positive mothers, the immunoprophylaxis measures should be appropriately taken; (5) to further reduce MTCT of HBV, pregnant women with HBV DNA levels >2×10 5 IU/mL or positive hepatitis B e antigen may receive oral antivirals, starting from 28 to 32 weeks of gestation and discontinuing the drug on the delivery day; (6) cesarean section is not recommended to reduce MTCT of HBV; (7) breastfeeding is recommended in infants of HBsAg-positive mothers, regardless of maternally positive hepatitis B e antigen, maternal nipple injury or bleeding, oral mucosal injury in neonates or infants; (8) breastfeeding is recommended in infants born to HBsAg-positive mothers who require continuation of antiviral therapy after delivery, and the infants should be followed up to observe whether adverse effects develop; and (9) the infants born to HBsAg-positive mothers should be tested for hepatitis B serological markers at the age of 7-12 months, and those who are negative for HBsAg and anti-HBs should receive three doses of hepatitis B vaccine on the 0, 1, and 6 month-schedule as soon as possible.

Objective: To explore the effect of hepatitis C virus (HCV) on the expression of serine protease inhibitor Kazal1 (SPINK1) and its clinical implication. Methods: mRNA and protein expression of SPINK1 in Huh7.5.1 cells infected by HCV JFH-1 and the control cells were measured by RT-PCR and western blotting, SPINK1 levels in the cell supernatants and sera of HCV patients were measured by enzyme-linked immunosorbent assay (ELISA), the difference of SPINK1 levels between healthy controls and HCV patients was analyzed. Results: Expression of SPINK1 mRNA and protein was higher in Huh7.5.1 cells infected by HCV JFH-1 than in the control cells, serum SPINK1 levels was much higher in HCV patients than in healthy controls (P=0.016). Conclusions HCV can upregulate the expression of SPINK1.

Objective To analyze the clinical manifestations and electroencephalogram (EEG)characteristics of agyria-pachygyria for its early diagnosis,treatment and prognosis judgment in clinical practice.Methods The clinical manifestations and EEG features of twenty-four patients with agyria-pachygyria who were diagnosed by CT or magnetic resonance imaging(MRI) at Pediatric Neurology of Children's Hospital of Chongqing Medical University from July 2004 to July 2013 were retrospectively analyzed.Results Of twenty-four patients,eighteen cases were diagnosed as diffuse agyria-pachygyria and six cases were diagnosed as partial agyria-pachygyria.The clinical features were mainly manifested as mental retardation (twenty-four patients),and motor retardation (twenty-four patients),and epilepsy (eighteen patients).All of the twenty-four patients had abnormal EEG pattern which were mainly three tapes.Type Ⅰ had diffused high amplitude alpha and beta activity in all cortical regions,frontal-central,or parietal-occipital region (fourteen patients).Type Ⅱ showed alternating high amplitude bursts with sharp and slow waves (seven patients).Type Ⅲ was characterized by high amplitude spike or sharp wave activity generalized or multifocal distribution and δ,θ wave mixing graphics (twelve patients).Nine of twenty-four patients showed two or three EEG characteristic patterns in an awake-asleep EEG recording.During the follow-up of 1-8 years old,twelve of the thirteen patients who were diagnosed as epilepsy in diffuse agyria-pachygyria had refractory epilepsy,mainly with infantile spasms or Lennox-Gastaut syndrome.One of the five patients who was diagnosed as epilepsy in focal agyria-pachygyria had refractory epilepsy,mainly for partial epilepsy secondary generalized seizures.There was a significant difference between them (P =0.008).Eighteen of twenty patients who had moderate-severe mental retardation or dyskinesia were diagnosed as diffuse a gyria-pachygyria,while two were focal agyria-pachygyria.Both of them had a significant difference (P =0.005).Conclusions Agyria-pachygyria is a brain malformation caused by neuronal migration abnormality.Diffuse agyria-pachygyria is presented with serious clinical manifestations and poor outcome while the clinical manifestation of focal agyria-pachygyria is relatively mild and epilepsy could be controlled by antiepileptic drugs or epilepsy surgery.These characteristics of EEG patterns along with clinical findings could provide important evidence for early diagnosis,timely treatment and prognosis judgment of agyria-pachygyria.