The article reports a rare case of isolated persistent left superior vena cava (PLSVC) found during the catheterization of a dialysis catheter in an end-stage renal disease patient and the occurrence of guidewire entrapment in Chiari net. The patient was scheduled to have emergency dialysis due to end-stage renal disease and acute left heart failure. And a tunnel-cuffed catheter (TCC) for dialysis insertion was planned. Isolated PLSVC was found firstly by the imaging process. Then the guidewire was entrapped at the right atrium in the further operation. During the operation of the guidewire, the guidewire loosened and withdrawn with a fine fiber, which was considered a possibility of Chiari net. In the follow-up after one week, the TCC worked well, and the heart function improved after dialysis.

Renal replacement therapy and perioperative management have difficulties in hemophilia patients with end-stage renal disease. The paper summarized the diagnosis and treatment experience of six hemophilia patients complicated with end-stage renal disease from January 1, 2000 to March 31, 2023 in Peking Union Medical College Hospital. Among 6 patients treated with peritoneal dialysis, 3 were treated with hemodialysis or continuous venous-venous hemodialysis. Altogether 11 dialysis access procedures were conducted successfully, and no serious bleeding or thrombotic events. In further conjunction with literature review, the paper summarized the key points of dialysis access appliance relevant to such patients, to provide reference for renal replacement treatment paths.

Extremely premature infants with <28 weeks of gestational age are at higher risk of various complications after birth and have higher mortality and disability rate due to the extremely immature organs. In recent years, with the rapid development of the perinatal medical system and related therapeutic technology, extremely preterm infants' short- and long-term prognosis has been significantly improved. Since the new century, with the rapid social and economic development, the number of treated extremely premature infants and its survival rate in China has also significantly increased. However, compared with the developed countries, the gap still exists. Here we outline the current situation of the management of extremely premature infants in China and abroad and the challenges we faced.

Objective:To investigate the expression of nicotinamide adenine dinucleotide (NAD +) digestive enzyme CD38 in normal and endotoxin-tolerant human monocyte THP-1 cell lines treated with lipopolysaccharide (LPS). Methods:(1) Normal THP-1 cells: The experiment and control group were treated with 100 ng/ml LPS for 1, 3, 6, 12 and 24 h or phosphate buffer for 24 h, respectively. Quantitative polymerase chain reaction (PCR) and Western blot were used to measure the expression of interleukin-6 (IL-6) and tumor necrosis factor (TNF) mRNA, CD38 mRNA and protein. (2) The induced endotoxin-tolerant THP-1 cells: ①The model of endotoxin-tolerant cells was established firstly by treating the THP-1 cells with 100 ng/ml LPS for 24 h. THP-1 cells treated with phosphate buffer were set as blank group. After further stimulating the two groups with LPS (100 ng/ml) for 3 h, mRNA levels of IL-6 and TNF were measured by quantitative PCR to determine whether the modeling was successful or not. ②In addition, the expression of CD38 mRNA were detected by quantitative PCR before and 12 h after LPS stimulation, and the expression of CD38 protein of these two groups were detected by western blotting before and 1, 6 h after LPS stimulation. Two independent samples t-test and repeated measurement analysis of variance were used for statistical analysis. Results:(1) In normal THP-1 cells, the mRNA expression levels of IL-6 and TNF in the LPS-stimulated cells were significantly higher than those of the control at all time points. And a higher expression level of CD38 mRNA and protein was observed in LPS-stimulated cells from 3 to 24 h compared with the control (mRNA at 3 h: 2.27±0.03 vs 1.00±0.18; protein at 3 h: 1.47±0.14 vs 1.00±0.16, both P<0.05). (2) Endotoxin-tolerant THP-1 cells: ①IL-6 and TNF mRNA levels in the model group were significantly lower than those in the blank group (both P<0.05), indicating that the endotoxin-tolerant THP-1 cell model was established successfully. ②Compared with the same points in the blank group, CD38 mRNA expression was upregulated in the model group before stimulating by LPS (14.18±1.19 vs 1.00±0.13, t=19.007) and 12 h after LPS stimulation (28.33±3.98 vs 7.61±0.88, t=8.803). Moreover, CD38 protein levels before stimulating by LPS (1.54±0.06 vs 1.00±0.10, t=7.796) and 1 h (1.59±0.09 vs 1.07±0.17, t=4.721), 6 h after LPS stimulation (2.48±0.09 vs 1.43±0.12, t=12.233) in the model group were all higher than those in the control group (all P<0.05). The intra-group comparison showed that in the model group the levels of CD38 mRNA at 12 h and CD38 protein at 6 h after LPS stimulation were significantly higher than those before (both P< 0.05). Conclusions:In both normal and endotoxin-tolerant THP-1 cells, LPS upregulates the expression of CD38, which is an NAD + digestive enzyme, and an indirect indicator of NAD + level in monocyte reinfection at the stage of immunosuppression. This study provides a preliminary reference for further investigation on the applicability of CD38 as a potential biological marker in the clinical diagnosis of neonatal sepsis.

Objective:To explore the risk factors for mortality in pediatric acute respiratory distress syndrome (PARDS) requiring extracorporeal membrane oxygenation (ECMO) support.Methods:Clinical data of 109 patients with severe PARDS supported by ECMO, who were hospitalized in 6 ECMO centers in China from September 2012 to February 2020, were retrospectively analyzed. They were divided into survival group and death group according to the prognosis. Chi-square test and rank sum test were used to compare the variables between the two groups, including the demographic data, laboratory examination results, clinical data before and after ECMO, and other supportive treatment. Univariate and multivariate Logistic regression models were used to analyze the prognostic risk factors.Results:In these 109 cases, 54 died and 55 survived. Compared with the survival group, the death group had higher incidences of acute kidney injury (AKI) (48.1% (26/54) vs. 21.8% (12/55) , χ2=8.318, P=0.004) and coagulation dysfunction (22.2% (12/54) vs. 7.3% (4/55) , χ2=4.862, P=0.027), and higher rate of renal replacement therapy (48.1% (26/54) vs. 21.8% (12/55) , χ2=9.694, P=0.008) during ECMO support. Logistic regression analysis showed that continuous renal replacement therapy (CRRT) and AKI were independent risk factors for death in patients with severe PARDS requiring ECMO support ( HR=3.88,95% CI 1.04-14.52, HR=4.84,95% CI 1.21-19.46, both P<0.05). Conclusion:AKI and CRRT are independent risk factors for predicting mortality in patients with severe PARDS requiring ECMO support.

Novel Coronavirus Pneumonia (NCP) is a class B infectious disease, which is prevented and controlled according to class A infectious diseases. Recently, children′s NCP cases have gradually increased, and children′s fever outpatient department has become the first strategic pass to stop the epidemic. Strengthening the management of the fever diagnosis process is very important for early detection of suspected children, early isolation, early treatment and prevention of cross-infection. This article proposes prevention and control strategies for fever diagnosis, optimizes processes, prevents cross-infection, health protection and disinfection of medical staff, based on the relevant diagnosis, treatment, prevention and control programs of the National Health and Health Commission and on the diagnosis and treatment experience of experts in various provinces and cities. The present guidance summarizes current strategies on pre-diagnosis; triage, diagnosis, treatment, and prevention of 2019-nCoV infection in common fever, suspected and confirmed children, which provide practical suggestions on strengthening the management processes of children′s fever in outpatient department during the novel coronavirus pneumonia epidemic period.

To report a 4-year-old boy with severed right index finger amputations in 2 segments. There were severe contusion on the 2 amputated sections of finger. According to the prevention and control requirement for the novel coronavirus disease(COVID-19), the patient was firstly checked to exclude the COVID-19. Then the replantation surgery was successfully carried out under the strict protective measures. The replanted index finger survived well at 2 weeks after surgery.

Trillions of microbes reside in the human body and participate in multiple physiological and pathophysiological processes that affect host health throughout the life cycle. The microbiome is hallmarked by distinctive compositional and functional features across different life periods. Accumulating evidence has shown that microbes residing in the human body may play fundamental roles in infant development and the maturation of the immune system. Gut microbes are thought to be essential for the facilitation of infantile and childhood development and immunity by assisting in breaking down food substances to liberate nutrients, protecting against pathogens, stimulating or modulating the immune system, and exerting control over the hypothalamic-pituitary-adrenal axis. This review aims to summarize the current understanding of the colonization and development of the gut microbiota in early life, highlighting the recent findings regarding the role of intestinal microbes in pediatric diseases. Furthermore, we also discuss the microbiota-mediated therapeutics that can reconfigure bacterial communities to treat dysbiosis.
Child ; Child, Preschool ; Disease ; etiology ; Dysbiosis ; therapy ; Gastrointestinal Microbiome ; drug effects ; Humans ; Infant ; Infant, Newborn

Objective: To investigate the effects of neonatal intensive care unit (NICU)-centered regional neonatal transport network (NTN) on the treatment of retinopathy of prematurity (ROP). Methods: A retrospective analysis was conducted to analyze the transfer, treatment and outcomes of 406 preterm infants with ROP who were transferred to the Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital via the NTN from July 2008 to December 2014. Independent sample t-test, Chi-square test and Mann-Whitney nonparametric test were used for statistical analysis. Results: Among the 406 premature infants who were transferred to our hospital because of ROP, there were 257 males and 149 females with the gestational age of (29.5±1.9) weeks (24⁺⁵-36 weeks) and the birth weight of (1 234.8± 268.9) g (580-2 400 g). The age at transfer was (48.9±18.5) d (15-78 d) and the transport distance was (216.5±78.6) km (10-625 km). No death was reported during the transportation. Very preterm births and very low birth weight infants (VLBWI) accounted for 88.7% (360 cases) and 82.5% (335 cases), respectively. Lesions occurred in 1, 2 and 3 zones were detected in 98 (24.1%), 286 (70.4%) and 22 (5.4%) cases, respectively. Lesions of stage 1-5 were observed in 51 (12.6%), 156 (38.4%), 183 (45.1%), 12 (3.0%) and 4 (1.0%) cases. There were 186 cases (45.8%) with Plus lesions. A total of 252 cases (62.1%) underwent surgery which were achieving treatment standards, including 165 (65.5%) undergoing laser therapy, 93 (36.9%) receiving anti-vascular endothelial growth factor (VEGF) therapy, 16 (6.4%) having vitrectomy and two (0.8%) having scleral buckling. Eighteen infants were diagnosed with retinal structural abnormalities, among which 16 had retinal detachment before admission (12 in phase 4 and four in phase 5). Two without retinal detachment on admission developed to phase 4 after surgery. The incidence of retinal structural dysplasia was 0.9% (2/236) in infants receiving laser and/or anti-VEGF therapy in our hospital. Compared with the cured patients (n=234), those with retinal structural dysplasia (n=18) had a late transfer time [80 (38-270) vs 50 (19-150) d, Z=3.387, P<0.001]. Conclusions The NICU-centered and regional transfer-based ROP treatment network provides timely and effective treatment for infants with ROP.

Objective To study the role of partial pressure of oxygen in the treatment of pulmonary hypertension induced by meconium aspiration syndrome. Methods Retrospective analysis was performed on 58 patients with meconium aspirate and pulmonary hypertension from January 1,2007 to December 31,2016, 28 patients in the death group,and 30 patients in the survival group. Blood gas analysis about two groups of children with mechanical ventilation were collected at four different time points:before mechanical ventilation ( 0 h) ,12 hours after mechanical ventilation,24 hours after mechanical ventilation and 72 hours after mechan-ical ventilation. The 80 mmHg(1 mmHg=0. 133 kPa) in blood gas analysis of the partial pressure of oxygen was used as the boundary point to study the effects about different blood oxygen partial pressures on the length of mechanical ventilation time in the survival group. Results Blood gas analysis showed that there were no significant differences in pH,partial pressure of oxygen,HCO3-,and lactic acid before mechanical ventilation in the two groups,but the pH values were significantly higher in the survival group after 12 h, 24 h,and 72 h of mechanical ventilation(t values:-2. 07,-3. 48,-7. 11;P <0. 05). Partial pressure of oxygen were higher in the surviving group at 12 h,24 h,and 72 h than those in the death group(t values-2. 87,-4. 88,-11. 29; P<0. 05). The HCO3-values of the survival group at 12 h,24 h and 72 h were higher than the death group, and the differences were statistically significant ( t values: -3. 90, -5. 60,-5. 76,P<0. 001). The lactic acid of survival group was significantly lower than the death group at 72 h after ventilation (t=5. 12,P<0. 001). Compared with the death group,partial pressure of carbon dioxide in 24 h,72 h decreased significantly in the surviving group(t values:5. 67,7. 60;P<0. 05). In the surviving group,the partial pressure of oxygen was maintained above 80 mmHg in 18 patients and the mechanical venti-lation time was (7. 17 ± 1. 95) d. The partial pressure of oxygen was below 80 mmHg in 12 patients of the surviving group and the mechanical ventilation time was (8. 67 ± 2. 50)d. The difference was statistically sig-nificant(t =12. 02,P <0. 001). Conclusion In the treatment of newborn with pulmonary hypertension caused by meconium aspiration,maintaining a higher pH value and a partial pressure of oxygen higher than 80 mmHg may be beneficial to the recovery of children with pulmonary hypertension.