Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objective:To explore the clinical warning value of ischemic modified albumin (IMA) and IMA to human serum albumin (HSA) ratio (IMAR) in the development of pre-eclampsia (PE) and its severity.Methods:A total of 156 pregnant women with PE admitted to the Haidian District Maternal and Child Health Hospital of Beijing from April 2022 to March 2023 were collected as the PE group, and 156 healthy pregnant women with the same age and gestational age were matched as the control group. PE pregnant women were further divided into severe PE group (78 cases) and non-severe PE group (78 cases). Severe PE pregnant women were divided into emergency group (42 cases) and non-emergency group (36 cases) according to the disease progression time.All pregnant women were stratified according to their HSA levels (<30 g/L, 30-32 g/L, ≥32 g/L), and the peripheral blood IMA, HSA, and IMAR of pregnant women in different periods and subgroups were compared, and also the difference of IMA levels in umbilical artery blood. Bivariate correlation analysis was used to explore the correlation between severe PE and IMA or IMAR, and receiver operating characteristic (ROC) curves was used to analyze the diagnostic value of IMA, HSA, and IMAR for PE and severe PE.Results:(1) The IMA level and IMAR in peripheral serum of pregnant women in the PE group at diagnosis, and the IMA level in umbilical artery blood at delivery, and peripheral serum at 2 days after delivery were higher than those in the control group. The HSA level in peripheral serum was lower than that in the control group at diagnosis, and the differences were statistically significant (all P<0.001). (2) The IMA level and IMAR in the peripheral serum of pregnant women with severe PE were higher than those in the non-severe PE group at diagnosis, while the HSA level were lower than those in the non-severe PE group. The differences were statistically significant (all P<0.05). At diagnosis, the IMA level and IMAR in peripheral serum of pregnant women in the emergency group were higher than those in the non-emergency group, while the HSA level was lower than that in the non-emergency group. The differences were statistically significant (all P<0.05). When diagnosed, the peripheral serum IMA levels of pregnant women in the PE group were compared between subgroups with HSA<30 g/L, 30-32 g/L, ≥32 g/L, and there was no statistically significant difference ( F=0.366, P=0.694). However, the IMAR was compared between the three subgroups, and the difference was statistically significant ( F=28.544, P<0.001), which increased with the decrease of HSA levels. In the subgroup with HSA≥32 g/L, the peripheral serum IMA level and IMAR of pregnant women in the PE group were higher than those in the control group at diagnosis, and the differences were statistically significant (all P<0.001). (3) The severe PE manifestations positively correlated with peripheral serum IMAR at diagnosis include systolic blood pressure ( r=0.279), mean arterial pressure ( r=0.212), and urinary protein quantification ( r=0.277), while the severe PE manifestations negatively correlated include HSA levels ( r=-0.644) and newborn birth weight ( r=-0.305), all of which were significantly correlated ( P<0.05). (4) The area under curve (AUC) for IMAR diagnosis of PE was 0.875 (95% CI: 0.833-0.916), with the highest diagnostic efficiency at a cutoff value of 2.06, sensitivity of 72.5%, and specificity of 85.1%. The AUC for diagnosing severe PE was 0.871 (95% CI: 0.822-0.919), with the highest diagnostic efficacy at a cutoff value of 2.18, sensitivity of 72.3%, and specificity of 88.3%. The diagnostic efficacy of IMAR for PE and severe PE were higher than those of IMA and HSA levels. Conclusions:The level of IMA and IMAR in pregnant women with PE are higher than those in normal pregnant women. IMA and IMAR are correlated with the severity of PE, with IMAR changes occurring earlier and more significantly. IMAR could be considered as one of the evaluation indicators for the development of PE, or as a more sensitive PE severity warning indicator than HSA.

Objective:To explore the effectiveness of the comprehensive healthcare management model for children with bacterial meningitis after discharge.Methods:This study was a retrospective cohort study that included 268 children with bacterial meningitis who were discharged from the infectious medicine ward of Beijing Children′s Hospital from September 2018 to September 2023. The children were managed with a multidisciplinary collaborative comprehensive healthcare management model after discharge. Outpatient data at 1 month and 6, 12 and 24 months after discharge were collected, including (height, weight, body mass index, nutritional feeding status, hearing and vision screening results, Gesell developmental assessment results and intervention guidance services. The follow-up interval or frequency was dynamically adjusted or increased according to the child′s situation. The paired sample t-test and chi square test were applied to compare the differences in Gesell developmental quotient (DQ) and developmental delay rate between the first and last assessments to preliminarily explore the effectiveness of the comprehensive healthcare management model for children with bacterial meningitis after discharge. Results:All the 268 children completed their first assessment one month after discharge, and 37 children were found to have abnormal physical growth, mainly obesity (28 children), and another 9 children were malnutrition. Nutritional intervention and feeding guidance services were provided to all the 37 children, and as of the last follow-up, 20 children′s physical growth evaluations had turned normal. A total of 188 children completed at least 2 developmental assessments, with an interval of (14.2±9.4) months between the first and last assessments (range: 3.1-49.5 months). The DQ values of in the energy region of adaptability, gross motor skills, fine motor skills, language, and personal social skills at the last assessment were significantly higher than those at the first assessment [(91.93±13.28) vs (80.73±15.96) points, (91.69±12.96) vs (78.31±16.58) points, (89.32±16.11) vs (80.68±15.63) points, (90.10±16.65) vs (82.04±18.43) points, (92.01±14.05) vs (77.82±17.42) points]; moreover, the rates of developmental delay in each energy region were significantly lower than those at the initial assessment (9.6% vs 35.1%, 9.6% vs 42.0%, 18.1% vs 33.0%, 13.3% vs 31.9%, 9.6% vs 42.0%) (all P<0.05). Among the 200 children who completed the hearing screening, 18 were found with hearing abnormalities, and 2 were diagnosed with hearing loss in the Otolaryngology Department. Among 217 children who completed vision screening, 23 had abnormalities, and 5 were diagnosed with ophthalmic abnormalities in Ophthalmology Department (2 with strabismus, 2 with refractive errors, and 1 with optic nerve injury). Two children were found to have autism-like behavior during monitoring, and were referred to a developmental behavior clinic to be diagnosed with autism spectrum disorder and were given early diagnosis and intervention guidance. Conclusion:The comprehensive healthcare management model for children with bacterial meningitis after discharge can integrate clinical and healthcare resources, which is beneficial for improving the prognosis and enhancing the quality of life for children with special health status.

Background/Aims: Chemoresistance is a common event after cancer chemotherapy, which is associated with the deregulation of circular RNAs (circRNAs). The objective of this study was to clarify the role of circ-LDLRAD3 in cisplatin (DDP)-resistant gastric cancer (GC). Methods: The expression of circ-LDLRAD3, miR-588, and SRY-box transcription factor 5 (SOX5) mRNA was detected by quantitative real-time polymerase chain reaction. Cell viability and the half maximal inhibitory concentration (IC 50 ) value were measured by CCK8 assay. Cell proliferation was assessed by colony formation and EdU assays. Cell apoptosis and cell invasion were assessed by flow cytometry assay and transwell assay, respectively. The expression of SOX5 protein was detected by Western blotting. A xenograft model was established to verify the role of circ-LDLRAD3 in vivo. Exosomes were isolated by differential centrifugation and identified by transmission electron microscopy and the expression of exosome-related proteins. Results: circ-LDLRAD3 was overexpressed in DDP-resistant GC tissues and cells. circ-LDL-RAD3 knockdown decreased the IC 50 of DDP-resistant cells and suppressed cell proliferation, survival and invasion. miR-588 was a target of circ-LDLRAD3, and miR-588 inhibition attenuated the inhibition of DDP resistance, proliferation, survival and invasion in DDP-resistant GC cells caused by circ-LDLRAD3 knockdown. SOX5 was a target of miR-588, and the inhibition of the DDP resistance, proliferation, survival and invasion of DDP-resistant GC cells by miR-588 restoration was largely rescued SOX5 overexpression. circ-LDLRAD3 knockdown inhibited DDP resistance and tumor growth in vivo. circ-LDLRAD3 was overexpressed in exosomes isolated from DDP-resistant GC cells. Conclusions circ-LDLRAD3 knockdown reduced DDP resistance and blocked the malignant development of DDP-resistant GC by modulating the miR-588/SOX5 pathway.

Objective To explore the MRI characteristics of anatomy and injuries of the tendons and ligaments in the midfoot.Methods Twenty healthy volunteers and 46 patients with midfoot trauma were selected for retrospective analysis.All subjects underwent examination on MR T1WI and proton density-fat suppression(PD FS)scans on three planes,respectively.Then the MRI features of tendon and ligaments injury were compared.Results The tendons and ligaments of 20 healthy volunteers(40 lateral feet)showed homogeneous low signal intensity with varing thickness.The anterior tibialis tendons showed a thin linear shape,and the posterior tibialis tendons showed a slightly thick band with uniform low signal intensity,and the calcaneonavicular ligament showed thin linelike low signal in different directions.In the 46 patients with midfoot injuries,there were 16 cases of anterior tibialis tendons injuries,18 cases of posterior tibialis tendons injuries,and 12 cases of calcaneonavicular ligament injuries.According to the MRI findings,the degree of injuries of tendons and ligaments was divided into injury,partial tear,and complete rupture.Conclusion MRI can clearly show the anatomy and injury features of ligaments and tendons in midfoot,which is of important value for the early diagnosis and accurate treatment of the ligaments and tendons injuries.

Objective:To evaluate the therapeutic effect of one-stage correction of upper eyelid laxity and glabella wrinkle with partial removal of interbrow depressor muscles and filling by autologous dermis.Methods:The clinical data of patients with upper eyelid skin laxity accompanied by prominent dynamic and static glabella wrinkle admitted to the Department of Plastic Surgery, Second Hospital of Nanjing from January 2018 to January 2021 were analyzed retrospectively. The upper eyelid was corrected with under-eyebrow incision or upper eyelid blepharoplasty. The resected skin from laxity was trimmed as autologous dermis for filling of glabellar wrinkle. Meanwhile, the descending brow muscle was also partially resected. All patients were followed up to observe the improvement of dynamic and static glabella wrinkles and related complications.Results:There were 16 cases, including 2 male cases and 14 female cases, aged from 37 to 57 years (mean 47.3 years). Primary healing was achieved in all cases without any hematoma and infection. Follow-up period lasted for 4-13 months. The upper eyelid laxity was corrected with improvement of dynamic and static glabella wrinkle. The patients were satisfied. Needle-like depressed scar happened in one case with no treatment. 1 case had slight prominent tissue between the eyebrows, which was improved by local injection of compound Betamethasone injection 6 months after operation. 2 cases had mild hypoplasia between the eyebrows without treatment. 2 cases had numbness, which was relieved spontaneously after 3 months.Conclusions:One-stage correction of upper eyelid laxity and glabella wrinkle with partial removal of interbrow depressor muscles and filling by autologous dermis can effectively improve periocular aging.

Objective:To evaluate the therapeutic effect of one-stage correction of upper eyelid laxity and glabella wrinkle with partial removal of interbrow depressor muscles and filling by autologous dermis.Methods:The clinical data of patients with upper eyelid skin laxity accompanied by prominent dynamic and static glabella wrinkle admitted to the Department of Plastic Surgery, Second Hospital of Nanjing from January 2018 to January 2021 were analyzed retrospectively. The upper eyelid was corrected with under-eyebrow incision or upper eyelid blepharoplasty. The resected skin from laxity was trimmed as autologous dermis for filling of glabellar wrinkle. Meanwhile, the descending brow muscle was also partially resected. All patients were followed up to observe the improvement of dynamic and static glabella wrinkles and related complications.Results:There were 16 cases, including 2 male cases and 14 female cases, aged from 37 to 57 years (mean 47.3 years). Primary healing was achieved in all cases without any hematoma and infection. Follow-up period lasted for 4-13 months. The upper eyelid laxity was corrected with improvement of dynamic and static glabella wrinkle. The patients were satisfied. Needle-like depressed scar happened in one case with no treatment. 1 case had slight prominent tissue between the eyebrows, which was improved by local injection of compound Betamethasone injection 6 months after operation. 2 cases had mild hypoplasia between the eyebrows without treatment. 2 cases had numbness, which was relieved spontaneously after 3 months.Conclusions:One-stage correction of upper eyelid laxity and glabella wrinkle with partial removal of interbrow depressor muscles and filling by autologous dermis can effectively improve periocular aging.

Objective To compare the efficacy and safety of two administration modes of autologous platelet-rich plasma (PRP),intradermal injection (ID) and microneedle technique in the treatment of facial post acne scars.Methods From March 2017 to March 2018,32 patients (8 male,14female) with facial acne scars were included.They were randomly divided into two groups (group A and group B) and both underwent splitface therapy.Each group was randomly divided into two subgroups.Group A was administered by microneedle + PRP (A1) on one side and by microneedle + saline (A2) on the other.In group B,one cheek was treated with ID PRP (B1) and the other received ID saline (B2).Each patient received overall 3 treatments per session with 28 days intervals.Patients were followed-up six months after their last treatment and clinical evaluation was assessed by 2 independent plastic surgeons and patients themself.Results The results were obvious difference between each group.The score of evaluation by physicians and patients in A1 group (2.565 ± 0.504) point showed significantly better results compared with other groups.B1 group (1.820±0.592) point was significantly higher than B2 group (1.345±0.483) point (P＜0.05).There were no statistical difference regarding scores of improvement between A2 group (1.405±0.499) point and B2 group (1.345±0.483) point (P＞0.05).The total effective rate in A1 group was 100％,which was higher than B1 group (43.75％),A2 group (81.25％) and B2 group (25％),with statistical significance (P＜0.05).Conclusions The current study introduces the combination of autologous PRP and microneedle technique as an effective and safe modality in the treatment of facial post acne scars with short recovery time and easy operation.Any concerns of immunogenic reactions or disease transfer are eliminated because PRP is prepared from autologous blood.Therefore,the method is suitable to be widely used in clinic.

Objective To establish the index system of nursing quality evaluation for patients with hematopoietic stem cell transplantation. Methods Based on the Donabedian structure-process-result three-dimensional quality management model, the evaluation index system of nursing quality of stem cell transplantation was constructed by combining qualitative and quantitative research of literature inquiry, case review, expert inquiry and analytic hierarchy process. Results Through the second round of expert consultation, the effective recovery rate of the expert questionnaire was 100% , the expert authority coefficient was 0.813, 0.859, and the coordination coefficient was 0.235 and 0.278 respectively (P< 01). Three primary indicators, 14 secondary indicators and 48 tertiary indicators were formed to evaluate the quality of care in stem cell transplantation. The index weight coefficient was established and the consistency test was passed. Conclusion The quality index system of hematopoietic stem cell transplantation nursing is well defined, its weight allocation is reasonable, the index is clear, and it is scientific and operational.

Objective To observe echocardiographic characteristics of bicuspid aortic valve (BAV) with Sievers classification.Methods Clinical and echocardiography data of 121 patients with BAV were retrospectively analyzed.According to Sievers classification,the patients were divided into type 0 (no raphe),type 1 (one raphe) or type 2 (two raphes).BAV of type 1 was further divided into three subtypes,including 1(L-R) subtype (the raphe positioned between the left and the right coronary sinuses),1(R-N) subtype (the raphe positioned between the right coronary sinus and non-coronary sinus) and 1 (N-L) subtype (the raphe positioned between the left coronary sinus and non-coronary sinus).The diameters of aorta in BAV patients with Sievers classification obtained with echocardiography were compared.Results There were 3 patients (3/121,2.48％) of type 0 and 118 patients (118/121,97.52％) of type 1 BAV.In patients of type 1 BAV,there were 80 cases (80/121,66.12％) of subtype 1 (L-R),33 (33/121,27.27％) of subtype 1 (R-N) and 5 (5/121,4.13％) of subtype 1 (N-L).There was no type 2 patient among these 121 cases.The diameters of the annulus and sinus of Valsalva in subtype 1 (R-N) BAV patients were less than those in subtype 1 (L-R) BAV (P=0.01,0.02).There was no significant difference of the diameters of the annulus,sinus of Valsalva,sinotubular junction nor the proximal ascending aorta among different subtypes of BAV (all P＞0.05).Conclusion Subtype 1(L-R) is more common in BAV patients,which often associated with larger diameters of annulus and sinuses of Valsalva than subtype 1 (R-N) on echocardiography.