Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective:To study the clinical characteristics of neonatal leukemoid reaction (NLR).Methods:The newborns with NLR admitted to the neonatal intensive care unit of the Seventh Medical Center of PLA General Hospital from September 2010 to January 2022 were selected as the observation group, and the newborns without NLR, who were admitted to the Hospital at the same time and matched with gestational age and birth weight of the NLR newborns were selected as the control group at a ratio of 1∶2. The gestational age, birth weight, maternal complications, maximum leukocyte count, percentage of neutrophils, C-reactive protein, hemoglobin, platelet count, disease diagnosis and other relevant information of the newborns were recorded, and SPSS 21.0 statistical software was applied to compare the data of the two groups of newborns.Results:A total of 36 cases were in the observation group and 72 cases in the control group. Naive granulocytes were found in the peripheral blood of all patients in the observation group, and leukocyte count was higher than that of the control group [61.7 (54.2, 90.6)×10 9/L vs. 19.6 (14.2,27.3)×10 9/L], the difference was statistically significant ( P<0.001), but there was no statistically significant difference in the percentage of neutrophils, hemoglobin, platelets, and C-reactive protein between the two groups ( P>0.05). The proportion of vaginal delivery, meconium-stained amniotic fluid, and neonatal sepsis in the observation group were higher than that in the control group [69.4% (25/36) vs. 38.9% (28/72), 19.4% (7/36) vs. 5.6% (4/72), 47.2% (17/36) vs. 8.3% (6/72)], and the proportion of gestational diabetes mellitus, gestational hypertension and prenatal use of glucocorticoid was lower than that in the control group, with statistical significance ( P<0.05). There was no significant difference in the incidence of premature rupture of membranes, neonatal asphyxia, intracranial hemorrhage, pulmonary hemorrhage, bacterial meningitis, and bronchopulmonary dysplasia between the two groups ( P>0.05). Conclusions:Newborns with NLR are frequently complicated with sepsis. Early prevention and treatment of maternal comorbidities and active control of infection are important for the prevention and treatment of NLR.

The cultivation of medical humanistic quality is indispensable in the standardized training of pediatric residents, and it is urgent to explore new educational methods to improve their medical humanistic quality level. In this study, 60 standardized pediatricians participated in the standardized training, 36 in the experimental group received innovative interactive medical humanities education, while 24 in the control group were set up to receive traditional medical humanities education. Short-term and long-term test scores were conducted by questionnaire at the beginning of the standardized training and 2 years later. The results showed that there was no significant difference between the experimental group and the control group in the self-scores of professional quality, moral cultivation, communication skills, legal knowledge and innovative spirit (P>0.05) , but the scores of teaching teachers were improved except innovative spirit (P<0.05) . In addition, compared with the control group, the number of pediatricians with professional honor increased, the doctor-patient communication ability improved, the medical disputes reduced, and the family satisfaction improved in experimental group were increased (P<0.05) . These results indicated that innovative interactive medical humanistic education is an effective method to improve the medical humanistic quality of pediatric residents in standardized training.

As a new group of stem cells found in the human breast in the 21st century, stem cells in human breast milk have the potential to differentiate into ectoderm, mesoderm, and endoderm cells.It is not only rich in sources, but also can be obtained in a non-invasive way.At present, there are relatively few ethical disputes.First, as a potential source of stem cells, it has a great prospect in the field of alternative medicine and regenerative medicine.Second, it can promote newborns early growth and development, repair the damaged tissues, and prevent as well as treat some early diseases.This review summarized stem cells from human breast milk, from aspects of distribution, acquisition, and functional characteristics, and discussed their application in newborns.

Objective:To analyze the clinical and gene mutation characteristics of congenital disorder of glycosylation (CDG) caused by compound heterozygous mutation of the COG6 gene ( COG6-CDG). Methods:This study retrospectively analyzed the clinical data and genetic test results of a patient with COG6-CDG in Bayi Children's Hospital, the Seventh Affiliated Medical Center of Chinese PLA General Hospital, in August 2019. Literature was retrieved with keywords including COG6, COG6-CDG, congenital disorders of glycosylation typeⅡL and congenital disorders of glycosylationⅡL in China National Knowledge Infrastructure, Wanfang Database, VIP Database, PubMed, and Web of Science Database from the establishment to July 2020, to summarize the clinical and genetic characteristics of COG6-CDG. Results:(1) Case report: The 59-day-old baby boy, with a gestational age of 27 +5 weeks and birth weight of 1 180 g, presented with multi-system involvement on admission, including unidentified progressive hepatosplenomegaly with jaundice and ascites, persistent thrombocytopenia, microcephaly, hypotonia, hypohidrosis, hyperkeratosis, and recurrent hyperthermia, infection, and hypoglycemia, as well as dysfunctions of the heart, gastrointestinal tract, lungs, kidneys, ocular fundus, and the coagulation system. Despite given ventilator-assisted ventilation, anti-infection therapy, abdominal puncture and drainage, and blood transfusion, the patient still had an aggravated condition and eventually died of multiple organ failures 192 d after birth. Genetic analysis showed that the nuclear family carried compound heterozygous mutations in the COG6 gene (NM_020751.2), including missense mutations of c.662C>T(p.T221M) in exon 7 and c.443T>C(p.I148T) in exon 5, which were both novel mutations and originated from the mother and father, respectively. (2) Literature review: Eight related papers were retrieved, including 20 cases. The main manifestations were various degrees of nervous system abnormalities and growth retardation, complicated by abnormalities of the liver, heart, gastrointestinal tract, blood, immunity, teeth, and bones. All the reported cases suffered from mental and growth retardation, and nine deaths were reported. A total of 11 COG6 gene mutations were identified, and most of them were c.1167-24A>G splicing mutations in a deep intron (seven cases), followed by c.1646G>T (four cases) and c.511C>T (three cases). Conclusions:COG6-CDG commonly manifests as multi-system and multi-organ dysfunctions with poor prognosis. Gene detection is conducive to the accurate diagnosis of COG6-CDG. Our case carries compound heterozygous mutations of c.662C>T(p.T221M) and c.443T>C(p.I148T), which are unreported novel mutations.

Objective:To study the effect of radiotherapy on the quality of life (QOL) of patients with bone metastasis of hepatocellular carcinoma by analyzing the Function Assessment of Cancer Treatment(FACT), and to analyze the influence of clinical factors on the improvement of the QOL after radiotherapy.Methods:The FACT bone pain scale in 43 patients with bone metastasis of hepatocellular carcinoma before and after radiotherapy was retrospectively analyzed. The changes in QOL score before and after radiotherapy were analyzed by T test from five aspects: overall QOL score, general functional status, pain degree, physical function and social psychology. Further analysis was made on the scores of patients whose QOL had not been improved. Chi-square test was used to analyze the correlation between clinical factors and QOL improvement after radiotherapy. Results:After radiotherapy, the QOL of patients were improved in all aspects compared with those before radiotherapy, and there were statistical differences ( t=7.621, 5.887, 9.407, 7.785, 4.487, P<0.05). In patients whose QOL did not improve after radiotherapy, the scores of overall QOL and psychosocial assessment decreased significantly, and there were significant differences ( t=3.381, 4.982, P<0.05). Among the clinical factors, soft tissue mass at bone metastasis site and radiotherapy prescription dose had significant effects on the improvement of patients′ life after radiotherapy (χ 2=5.180, 7.457, P<0.05). Whether there were soft tissue masses in bone metastases before radiotherapy, the improvement rates of QOL after radiotherapy were 50.00% and 85% respectively. The improvement rates of QOL after radiotherapy were 44.44% and 84% in patients with prescription dose of <40 Gy and≥40 Gy respectively. Multivariate analysis showed that soft tissue mass at bone metastasis site, the dose of radiotherapy prescription and numeric rating scale (NRS) of pain had more significant effects on QOL ( OR=0.296, 0.020, 1.592, P<0.05). Conclusions:Radiotherapy at bone metastasis sites can significantly improve the QOL of liver cancer patients with bone metastasis. Psychosocial status can affect the QOL of patients. In the case of soft tissue mass in bone metastasis site, the prescription dose of radiotherapy (≥40 Gy) can better improve the QOL.

Objective: To study the threshold values of lactic acid (Lac)and buffuer excess (BE) when neonatal umbilical arterial blood gas is at pH <7.20. Methods: A total of 2 518 pregnant women admitted in Beijing New Century Women and Children′s Hospital from January 2017 to February 2019 were enrolled.The general conditions in perinatal period and labor methods were counted.Umbilical cord arterial blood was immediately collected before the first cry of newborn and was detected on the Abbott I-STAT automatic blood gas analyzer from the United States, and then the umbilical arterial blood gas was measured.We analyzed the perinatal factors affecting umbilical arterial blood gas.We studied the threshold values of Lac and BE for neonal asphyxia by receiver operating characteristic curve. Results: (1)Maternal anemia, Streptococcus agalactiae infection, precipitate labour, placenta abnormalities had no significant impact on neonatal umbilical artery blood gas.The Lac value in blood gas was higher in the group of premature rupture of fetal membranes and fetal intrauterine distress.The value of BE was lower in the group with premature rupture of fetal membranes and fetal distress (P<0.05). The Lac value in cesarean section group was the lowest[(1.79±1.25) mmol/L], while that in midwifery group was the highest[(4.45±1.58) mmol/L]. pH value was the lowest (7.25±0.07) in the midwifery group and the highest (7.31±0.06) in the cesarean section group.The value of BE was the lowest in the midwifery group[-(5.66±2.52) mmol/L], and the highest in the cesarean section group[-(2.99±2.28) mmol/L], with statistically significant differences among the three groups (P<0.05). (2) Multiple linear regression analysis showed that fetal delivery mode, fetal intrauterine distress, premature rupture of membranes, and gestational diabetes were the factors affecting Lac level in umbilical artery blood gas of newborns.Methods of delivery, intrauterine distress, premature rupture of membranes and placental abnormalities were the factors that affected the BE value of umbilical artery blood gas in newborns.(3) A total of 199 cases with pH value <7.2 were diagnosed as asphyxia, and the receiver operating characteristic curve of Lac and BE values of neonatal umbilical artery blood gas for the diagnosis of asphyxia was drawn.When Lac was >3.97 mmol/L, the sensitivity and specificity of the diagnosis of asphyxia were 0.864 and 0.791, respectively.When BE was ≤-6 mmol/L, the diagnostic sensitivity and specificity of asphyxia were 0.613 and 0.756, respectively. Conclusion Neonatal umbilical arterial blood gas is affected by many factors.The effect of accouche on umbilical arterial blood gas is large.When there is asphyxia with pH <7.2, the cut points of Lac and BE are >3.97 mmol/L and ≤-6 mmol/L, respectively.

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.

Objective To investigate the risk factors affecting the prognosis of preterm infants with septic shock. Methods A retrospective study was conducted to analyze the clinical data of 114 preterm children with septic shock admitted to the Neonatal Intensive Care Unit (NICU) of the PLA Army General Hospital from February 2014 to January 2017. According to the outcomes, these cases were divided into two groups, the cured group and the death group (including those died after ineffective treatment and withdrawal of treatment). Clinical data including the general clinical data, perinatal risk factors, clinical features and prognosis of the two groups of children, as well as the occurrence of related complications were statistically analyzed by t-test, Wilcoxon nonparametric test, Chi-square test or Fisher's exact probability method. Logistic regression was used to analyze the factors influencing the prognosis. Predictive values of the indicators were evaluated using receiver operating characteristic (ROC) curve. Results (1) Among the 114 patients, 87(76.3%) were cured and 27(23.7%) were dead. (2) In the death group, there were more infants complicated with amniotic fluid pollution, anemia and thrombocytopenia (platelet count <100×109/L) and the C-reactive protein (CRP) levels were higher than those in the cured group [29.6% (8/27) vs 8.1% (7/87), χ2=6.618; 22.2% (6/27) vs 5.9% (5/87), χ2=4.665; 59.3% (16/27) vs 23.3% (20/87), χ2=12.546; 36.0 (1.0-80.0) mg/L vs 7.5 (1.0-25.0) mg/L, Z=2.400], while the hemoglobin level was lower [(122.2±43.3) g/L vs (140.5±34.4) g/L, t=2.260] (all P<0.05). (3) The percentages of infants with patent ductus arteriosus, pulmonary hemorrhage and coagulopathy in the death group were higher than those in the cured group [81.5% (22/27) vs 60.9% (53/87), χ2=3.871; 37.0% (10/27) vs 12.6% (11/87), χ2=6.616;48.2% (13/27) vs 20.7% (18/87), χ2=7.847; all P<0.05]. (4) Multivariate logistic regression analysis showed that amniotic fluid contamination, coagulopathy, patent ductus arteriosus and CRP level were risk factors for poor prognosis in neonates (all P<0.05). (5) A total of 77 pathogens were isolated from the 114 infants with 66 in the cured group and 11 in the death group. Pathogens of Gram-positive and Gram-negative bacteria and fungi in the cured and death groups accounted for 37.9% (25/66) vs 3/11, 37.9% (25/66) vs 6/11, and 24.2% (16/66) vs 2/11, respectively. No significant difference in pathogen distribution was observed between the two groups. (6) The area under the ROC curve of CRP was 0.649 (P=0.024). When the cut-off value of CRP was set at 31 mg/L, the sensitivity and specificity for predicting adverse outcomes in preterm infants with septic shock were 0.802 and 0.556, respectively, and the Yoden index was 0.358. The area under the ROC curve of thrombocytopenia was 0.708 (P<0.001). When the platelet level was set at 94×109/L, its sensitivity and specificity were 0.767 and 0.593, respectively, and the Yoden index was 0.360. Conclusions Amniotic fluid contamination, patent ductus arteriosus, coagulopathy and elevated CRP are important risk factors for death in preterm infants with septic shock. Thrombocytopenia and persistently elevated CRP has predictive values for the prognosis of preterm infants with sepsis shock.

Objective To study the changes and significance of inflammatory cytokines and pulmonary surface protein (SP) level in respiratory failure of full-term infants.Method Prospectively selected 30 cases of term baby with respiratory failure requiring mechanical ventilation and pulmonary surfactant (PS) treatment in BaYi Children's Hospital from May 2016 to January 2017 as case group,while 30 cases of term baby with transient tachypnea or hypoglycemia were control group.Blood samples were collected at the first and third day of hospitalization.The interleukin-6 (IL-6),IL-10,and tumor necrosis factor-α (TNF-α) were detected by flow cytometry,serum SPs were detected by enzyme-linked immunosorbent assay method.The statistical analyses were conducted by SPSS 22.0 software.Result The levels of IL-6,IL-10,SP-A,SP-B and SP-C in the case group were significantly higher than those in the control group [IL-6:172.4 (58.4,668.4) ng/L vs.8.3 (5.7,11.2) ng/L,IL-10:10.2 (5.9,31.5) ng/L vs.4.7 (3.6,7.1) ng/L,SP-A:6.94 (2.37,29.64) μg/L vs.0.56 (0.50,0.64) μg/L,SP-B:4.36 (1.99,5.25)μg/L vs.1.44 (1.25,1.79) μg/L,SP-C:0.87 (0.19,2.66) μg/L vs.0.14 (0.10,0.16) μg/L,P ＜0.05].After exogenous PS treatment,serum SP-A,SP-B,SP-C,IL-6 and IL-10 levels in the surviving group were significantly lower comparing with the first day (P ＜ 0.05).The IL-6,SP-A and SP-C levels in the first day death group were significantly higher than those in survival group(P ＜ 0.05).Conclusion Inrespiratory failure of full-term infants,serum IL-6 levels are consistent with the SP-A and SP-C levels,and a sustained increase may serve as a potential early biomarker for disease progression.