Objective To evaluate the intravascular volume at different levels of edema and disease course by the fractional excretion of filtered sodium(FeNa)of children with primary nephrotic syndrome(PNS).Methods A total of 172 children with newly diagnosed PNS who were hospitalized in the Affiliated Hospital of Xuzhou Medical University from September 2022 to September 2024 were selected and divided into non-e-dema group(n=51),mild edema group(n=43),moderate edema group(n=46)and severe edema group(n=32)according to the degree of edema at the time of admission.A total of 40 healthy children who underwent physical examination during the same period were selected as the healthy control group.Serum creatinine,ser-um sodium were detected before and after treatment.Urine samples were collected to detect urine creatinine,urine sodium,FeNa was calculated and compared according to the results,and the degree of edema was recor-ded.24 h urine samples were collected on the same day to detect 24 h urine protein quantification and 24 h u-rine volume.Results On day 1 to 2 of the course of the disease,about 12%of the PNS children had FeNa<0.2%,indicating insufficient intravascular volume,which was mainly concentrated in the severe edema group.The moderate,severe edema group had a significantly lower FeNa level than the non-edema group,mild edema group,and healthy control group(P<0.01).The moderate edema group had a significant increase in FeNa on days 6 to 7 of the course of the disease,and the severe edema group had a significant increase in Fena on days 11 to 12 of the course of the disease(P<0.01).Conclusion Intravascular volume of PNS children with mod-erate to severe edema is often reduced,and intravascular volume may be insufficient in severe edema.PNS chil-dren with moderate to severe edema have increased intravascular volume with the extension of the course of disease and the improvement of the condition.

With the latest development of information and communication technology, mobile applications for health care have attracted much attention to help cancer patients better manage their diseases. Digital therapeutics is an evidence-based intervention driven by high-quality software programs that prevent, manage, or treat medical disorders or diseases. This paper summarizes the origin, concept and characteristics of digital therapeutics and the application form, effect, challenge and opportunity of symptom management in cancer patients, in order to provide reference for the scientific and efficient application of Digital therapeutics to cancer patients.

Chronic diseases have become a major threat to the physical and mental health of children, and effective disease management is especially important for children, families and society. Currently, shared decision-making is receiving widespread attention from the international community, providing a new way of thinking and method for the management of chronic diseases in children. The purpose of this paper is to describe the concepts related to shared decision-making in the field of pediatrics, introduce the theoretical model, implementation content and obstacles of shared decision-making for children with chronic diseases, as well as provide suggestions and outlooks for promoting the implementation of shared decision-making for children with chronic diseases, with a view to providing useful references for the further application of shared decision-making in children with chronic diseases.

With the latest development of information and communication technology, mobile applications for health care have attracted much attention to help cancer patients better manage their diseases. Digital therapeutics is an evidence-based intervention driven by high-quality software programs that prevent, manage, or treat medical disorders or diseases. This paper summarizes the origin, concept and characteristics of digital therapeutics and the application form, effect, challenge and opportunity of symptom management in cancer patients, in order to provide reference for the scientific and efficient application of Digital therapeutics to cancer patients.

Chronic diseases have become a major threat to the physical and mental health of children, and effective disease management is especially important for children, families and society. Currently, shared decision-making is receiving widespread attention from the international community, providing a new way of thinking and method for the management of chronic diseases in children. The purpose of this paper is to describe the concepts related to shared decision-making in the field of pediatrics, introduce the theoretical model, implementation content and obstacles of shared decision-making for children with chronic diseases, as well as provide suggestions and outlooks for promoting the implementation of shared decision-making for children with chronic diseases, with a view to providing useful references for the further application of shared decision-making in children with chronic diseases.

Objective To observe the distribution of atypical memory B cells in peripheral blood of children with frequently relapsing nephrotic syndrome(FRNS).Methods A total of 60 children with primary ne-phrotic syndrome(PNS)admitted to the hospital from October 2020 to March 2023 were selected as the re-search objects.According to the response to glucocorticoid(GC),they were divided into non-frequently relap-sing nephrotic syndrome(NFRNS)group(25 cases)and FRNS group(35 cases).A total of 20 age-and gen-der-matched healthy children were enrolled as the control group.The changes of atypical memory B cells in each group before and after GC treatment were compared,and the correlation between the changes and clinical data was analyzed.Results Before GC treatment,The percentages of total B cells(CD19+CD20+),total memory B cells(CD19+CD20+CD27+),resting memory B cells(CD19+CD20+CD21+CD27+)and atypical memory B cells(CD19+CD20+CD21-CD27-)in FRNS group and NFRNS group were significantly higher than those in control group.And the FRNS group was significantly higher than the NFRNS group(P＜0.05).After GC treatment,the percentages of total B cells,total memory B cells,resting memory B cells,acti-vated memory B cells(CD19+CD20+CD21-CD27+)and atypical memory B cells in FRNS group and NFRNS group were lower than those before GC treatment(P＜0.05).The FRNS group had a significantly higher pro-portion of atypical memory B cells than the NFRNS group and the control group(P＜0.05).Before GC treat-ment,the 24 h urinary protein in FRNS group and NFRNS group were higher than those in control group,and the levels of immunoglobulin G and albumin were lower than those in control group.The 24 h urinary protein in FRNS group was significantly higher than that in NFRNS group(P＜0.05).Before GC treatment,there was a positive correlation between 24 h urinary protein and the proportion of atypical memory B cells in FRNS group(P＜0.05).Conclusion There is abnormal distribution of atypical memory B cells in peripheral blood of FRNS children.The increase of atypical memory B cells can be used as a marker of recurrence of FRNS af-ter GC treatment.

Objective To investigate the risk factors and clinical characteristics of asphyxia-related acute kidney injury (AKI) in neonates. Methods A retrospective analysis was conducted on the clinical data of neonates with asphyxia-related AKI (AKI group, n=100) and asphyxia withont AKI neonates (control group, n=228) admitted to the neonatal intensive care unit (NICU) of the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2023. Laboratory indicators and clinical data from both groups were collected to analyze the risk factors and clinical characteristics of asphyxia-related AKI in neonates. Results Statistically significant differences were observed in levels of lactate, base excess (BE), serum potassium, serum creatinine, and urea nitrogen between the AKI and control groups (P < 0.05). Multivariate Logistic regression analysis revealed that low 5-minute Apgar score, high lactate level, and hyperglycemia were independent risk factors for asphyxia-related AKI in neonates. The areas under the curve (AUCs) for the 5-minute Apgar score, lactate, and blood glucose in predicting AKI were 0.825(95%CI, 0.767 to 0.882), 0.968(95%CI, 0.942 to 0.993), and 0.845(95%CI, 0.795 to 0.894), respectively. The incidence of maternal hypertension during pregnancy also showed a significant difference between the two groups (P < 0.05). Significant differences were also noted in 1-minute and 5-minute Apgar scores, as well as the incidence of intrauterine distress between the AKI and control groups (P < 0.05). Furthermore, the AKI group exhibited statistically significant differences in respiratory distress syndrome (RDS), respiratory failure, necrotizing enterocolitis (NEC), severe intracranial hemorrhage, pulmonary hemorrhage, use of diuretics, and blood purification etc. compared to the control group (P < 0.05). There were 24 deaths in the AKI group, with 16 cases in AKI stage 3 and 8 cases in AKI stage 2, while only 3 deaths occurred in the control group. The difference in mortality rate between the two groups was statistically significant (P < 0.05). Conclusion Low 5-minute Apgar score, high lactate levels, and hyperglycemia are independent risk factors for AKI in neonates. Neonates with AKI are prone to developing multi-organ dysfunction, and asphyxia-related AKI can increase mortality rates. Therefore, comprehensive prevention and treatment measures are crucial.

We report a case of a 2 200 g premature male baby born through cesarean section under maternal endotracheal intubation mechanical ventilation combined with extracorporeal membrane oxygenation at 34 +1 gestational weeks, while his mother was infected with influenza A in late pregnancy. Due to neonatal pneumonia, neonatal respiratory distress syndrome, prematurity, and low birth weight, the neonate was transferred to the neonatal intensive care unit for body temperature maintenance, respiratory support, maintenance of perfusion and internal environment, and nutritional management. The infant was discharged 17 days after birth and was well at six-month-old follow-up. His mother was discharged at 20 days post-delivery.

Objective To evaluate the relative efficacy of different dosages of Calf Pulmonary Surfactant (Calsurf) administration in premature infants with established respiratory distress syndrome (NRDS).Methods Four neonatal intensive care units in Jiangsu province were enrolled.Premature infants,birth weight ＜ 2 500 g,with NRDS,received 70 mg/kg (61 cases)or 100 mg/kg (69 cases)Calsurf.Clinical and respiratory parameters were recorded.The primary outcome measures were blood gas analysis of 1 h,12 h and 36 h after administration,the need for oxygenation and ventilatory requirements and the adverse events of NRDS.Results Arterial oxygen tension[pa (O2)] results in a significant improvement(80.27-±36.81) mmHg,(73.03 ±24.94) mmHg and (72.35 ± 24.72) mmHg at 1 h,12 h and 24 h in higher dose group(P ＜ 0.05),(67.95 ± 23.79) mmHg,(72.35 ± 24.72) mmHg in 24 h,as compared with the lower dose group at the same time [(67.07 ± 19.94) mmHg,(62.93 ± 21.71) mmHg,(67.95 ±-23.79) mmHg] (P ＞ 0.05).Inspired oxygen (FiO2) and pa (O2) decreased after administration in two groups and the duration of FiO2 decline lasted to 48 h (all P ＜ 0.05).The oxygen index (OI) was improved after Calsurf administration,especially in the infants who received 100 mg/kg of Calsurf with 6.1 ± 2.8,5.6 ± 3.3,5.5 ± 3.5,5.8 ± 4.5,5.3 ± 3.1 in 1 h,12 h,24 h,36 h,48 h,respectively(P ＜ 0.01).The arterial-to-alveolar oxygen tension ratio (a/APO2) of 100 mg/kg group was reduced significantly in 1 h,12 h,24 h,36 h,48 h with 0.39 ±0.22,0.42 ±0.20,0.45 ± 0.22,0.44 ± 0.22,0.46 ± 0.21 as compared with 0.27 ± 0.18 which was at the time point before administration (P ＜ 0.01).Although not statistically significant,the mean time of duration of mechanical ventilation and oxygen inhalation of higher dose group were decreased as compared to the lower dose group [(94.54 ± 113.44) h vs (109.27 ± 124.87) h (P＞0.05) and (259.10 ±280.45) vs (372.31 ±398.08) h(P ＞0.05)].There were no significant differences in the rates of other adverse events such as pneumonia,pneumothorax,intracranial hemorrhage,patent ductus arteriosus (PDA),pneumorrhagia,necrotizing enterocolitis,septicemia between two groups (P ＞ 0.05).Conclusions Calsurf given to preterm infants with NRDS at a dose of 100 mg/kg resulted in a higher Pa (O2),a/APO2,better OI and lower FiO2 as compared with those receiving 70 mg/kg.The need for mechanical ventilation and oxygen supplement were reduced with higher-dose administration.Large dose of Calsurf did not increase the risk of complications as mentioned above.

Objective To study the baseline level of fraction anisotropy (FA) and the normal value of apparent diffusion coefficient (ADC) in deep white matter of preterm and its application.Methods From Oct.2010 to Dec.2013,in Department of Neonatology,Jiangsu Province Hospital,magnetic resonance imaging (MRI) (T1,T2) and diffusion tensor imaging (DTI) were done on 13 preterm infants of less than 37 weeks of corrected gestational age (CA),42 preterm infants of term-matched age,and 15 term infants.ADC and FA were measured in genu and splenium of corpus callosum (CC),anterior limb and posterior limb of internal capsule (IC).Results 1.The ADC values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were higher than those in term-matched infants and in term infants.The ADC values in the 6 regions in term-matched infants and in term infants were significantly different with those in CA ＜ 37 weeks infant(F =5.559,5.775,21.948,19.462,30.586,15.452,all P ＜ 0.01).The differences of ADC values between CA ＜ 37 weeks infants and term-matched infants,between CA ＜37 weeks infants and term infants were significant(all P ＜0.05),except that in CC between CA ＜ 37 weeks infants and term-matched infants.2 The FA values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were lower than those in term-matched infants and in term infants.The FA values in the 6 regions in term-matched infants and in term infants were significantly different from those in CA ＜ 37 weeks infants (F =9.835,7.500,4.811,11.430,8.674,12.666,all P ＜ 0.01).The differences of FA values between CA ＜ 37 weeks infants and term-matched infants (P ＜ 0.05),between CA ＜ 37 weeks infants and term infants were significant (all P ＜ 0.05).Conclusions The baseline values of FA and ADC in different deep white matters were obtained.As corrected gestational age of preterm babies' increased,FA values in brain white matter increased,while ADC values decreased.The myelination in most white matter of preterm infants at matched term can catch up with that of term infants.The diagnostic value of ADC and FA needs to be studied further.