Background During pregnancy, negative emotions such as anxiety and depression may induce cortisol disruption. Cortisol can be transmitted to the fetus through the placental barrier, thereby affecting the neurodevelopment of the offspring. Objective To investigate the relationship between placental cortisol, maternal depression during pregnancy, and neurodevelopment of 3-month-old infants. Methods From September 2022 to September 2023, 171 pregnant women ordered routine prenatal checks at the obstetrics outpatient department of a tertiary hospital in Ningxia were selected using a prospective cohort design. After providing informed consent, these women participated in a questionnaire survey that covered general individual characteristics, prenatal depression, and sleep quality. At birth, placental samples were collected to measure cortisol levels using ELISA kits. Follow-up assessments on the neurodevelopmental of 3-month-old infants were conducted using the Warning Sign for Children Mental and Behavioral Development. LASSO regression analysis was conducted to screen the influencing factors of depression during pregnancy. Huber regression analysis was then applied to assess potential linear relationship between depression during pregnancy and placental cortisol levels. Log-binomial regression was used to analyze the linear relationships between cortisol levels and neurodevelopmental delay in 3-month-old infants. Additionally, a mediation effect model was fitted using R 4.3.3 to assess possible mediating role of cortisol in the association between prenatal depression and neurodevelopmental delay in 3-month-old infants. Results The positive rate of prenatal depression was 33.33%. Nine factors affecting prenatal depression were identified by LASSO regression, including rural residence, high school education or above, extroverted personality characteristics, moderate early pregnancy reactions, baby sex expectation, prenatal anxiety, family dysfunction, exposure to stressful life events during pregnancy, and moderate prenatal sleep quality. The Huber regression model showed a positive linear correlation between prenatal depression and placental cortisol (P<0.05). With or without controlling confounding factors, the results of log-binomial regression modeling showed that cortisol levels were associated with a reduced risk of neurodevelopmental delay in 3-month-old infants (crude model: RR=0.988, 95%CI: 0.9768, 0.9996, P＜0.05; adjusted model: RR=0.988, 95%CI: 0.9764, 0.9993, P＜0.05). A mediating effect of placental cortisol between prenatal depression and the risk of neurodevelopmental delay in 3-month-old offspring was found statistically significant (P=0.045), accounting for 67.0% of the total effect. Conclusion Prenatal depression is associated with elevated placental cortisol levels, and higher cortisol levels are found to be related to a lower risk of neurodevelopmental delay in infants. Placental cortisol mediates the relationship between prenatal depression and infant neurodevelopment.

Background Job burnout and depressive symptoms are prevalent among occupational populations, with a close relationship between them. Sleep quality, as a potential mediating factor, significantly affects the mental health of workers. Objective To explore the relationship between job burnout, sleep quality, and depressive symptoms, and determine whether sleep quality mediates the relationship between job burnout and depressive symptoms. Methods From April 25 to May 1, 2024, this study employed cluster sampling to conduct a questionnaire survey among individuals engaged in various occupations across five cities in the Ningxia Hui Autonomous Region. The questionnaires included socio-demographic information, as well as the Chinese Maslach Burnout Inventory (CMBI), the Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-9 (PHQ-9) for assessing burnout, sleep quality, and depressive symptoms, respectively. Out of the 4106 questionnaires distributed, a total of 3837 questionnaires were valid, and the valid recovery rate was 93.45%. The distribution among demographic variables in burnout, sleep quality and depressive symptoms were statistically analyzed. A binary logistic regression model was used for multifactor correlation analysis; Pearson correlation was used to test the correlation between burnout, sleep quality, and depressed mood. Modelling and mediated effect path mapping were performed using Amos 24.0 software. Results The postive rate of occupational burnout in the workers was 97.49% (3741/3837), the positive rate of poor sleep quality was 66.77% (2526/3837), and the positive rate of depressive symptoms was 75.68% (2904/3837). There were statistically significant differences in depressive symptoms by ages, shift types, working years, marital status, smoking habits, drinking habits, and exercising frequency (P < 0.05). The logistic model indicated that working years, drinking habits, job burnout, and overall sleep quality were significant factors influencing the occurrence of depressive symptoms (P < 0.05). The correlation analysis revealed positive correlations between depressive symptom scores and job burnout scores (r=0.045, P < 0.01), between depressive symptom scores and sleep quality scores (r=0.480, P < 0.01), and between job burnout scores and sleep quality scores (r=0.054, P < 0.01). Furthermore, the indirect effect of job burnout on depressive symptoms through sleep quality was 0.100 (95%CI: 0.204, 0.252; P < 0.01). Conclusion Job burnout and sleep quality are significant factors associated with the occurrence of depressive symptoms among occupational populations, and sleep quality plays a partial mediating role in depressive symptoms associated with job burnout. This finding may provide a scientific basis for developing intervention strategies to control depressive symptoms among workers.

Objective:To explore the characteristics of SLCO1B1/ SLCO1B3 gene variants among children with Rotor syndrome (RS). Methods:Four children who were admitted to the Department of Hepatology of Hunan Children′s Hospital between January 2019 and January 2022 were selected as the study subjects. Trio-whole exome sequencing was carried out for the four families, and gel electrophoresis was used to verify an insertional variant of long-interspersed element-1 (LINE-1).Results:Genetic testing has identified three variants of the SLCO1B1 gene, including c. 1738C>T (p.R580*), c. 757C>T (p.R253*) and c. 1622A>C (p.Q541P), and two variants of the SLCO1B3 gene, including c. 481+ 22insLINE-1 and c. 1747+ 1G>A among the children. Three of them were found to harbor homozygous variants of the SLCO1B1/ SLCO1B3 genes, and one has harbored compound heterozygous variants. Sanger sequencing confirmed the existence of all variants, and gel electrophoresis has confirmed the existence of the LINE-1 insertional variant of about 6 kb within intron 6 of the SLCO1B3 gene in all children. Conclusion:The pathogenesis of the RS among the four children may be attributed to the variants of the SLCO1B1/ SLCO1B3 genes. The LINE-1 insertion variant of the SLCO1B3 gene may be common among Chinese RS patients.

Objective To investigate the change in mucosal-associated invariant T (MAIT) lymphocytes in peripheral blood of children with metabolic associated fatty liver disease (MAFLD) and its clinical significance. Methods A total of 18 children with MAFLD who attended Hunan Children's Hospital from March to May, 2022, were enrolled as MAFLD group, and 20 normal children who attended the hospital during the same period of time were enrolled as control group. Peripheral blood samples were collected, and flow cytometry was used to measure the percentages of MAIT lymphocytes (CD3 + CDl61 + TCRVα7.2 + cells), different MAIT lymphocyte subsets (CD4 + CD8 - MAIT cells, CD4 - CD8 - MAIT lymphocytes, CD4 - CD8 + MAIT lymphocytes, and CD4 + CD8 + MAIT lymphocytes), and MAIT lymphocytes expressing PD-1, CD69, perforin, CD107α, CXCR3, CXCR6, and CCR6. The correlation of MAIT lymphocyte frequency with liver inflammation, fat content, and fibrosis degree was analyzed. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Spearman correlation analysis was used for correlation analysis. Results Compared with the control group, the MAFLD group had significant increases in the percentage of MAIT lymphocytes in peripheral blood, the percentages of MAIT cells expressing PD-1, CD69, CD107α, CXCR3, CXCR6 and CCR6, and the percentages of CD4 + CD8 - MAIT cells and CD4 + CD8 + MAIT lymphocytes among MAIT cell subsets (all P < 0.05), as well as a significant reduction in the percentage of CD4 - CD8 + MAIT cells among MAIT cell subsets ( P < 0.001). The percentages of CD4 + CD8 + MAIT lymphocytes and CD107α-positive MAIT lymphocytes were negatively correlated with alanine aminotransferase ( r =-0.474 and -0.550, P =0.047 and 0.018). Conclusion The migration of peripheral blood MAIT lymphocytes to the liver plays a protective role against liver inflammation in children with MAFLD.

Objective:To understand the clinical and genetic characteristics of hereditary spherocytosis (HS) combined with cholestasis among pediatric patients.Methods:12 cases of HS children accompanied by cholestasis at Hunan Children's Hospital were selected as the research subjects between January 2013 and December 2022. Clinical data were collected. Whole-exome sequencing was performed by second-generation sequencing. Suspected pathogenic mutation sites were verified by Sanger sequencing.Results:All pediatric patients were admitted to the hospital due to their yellow skin tone. Eight cases (66.67%) had a positive family history. The clinical manifestations were jaundice, splenomegaly (12/12), abdominal pain, anemia (4/12), and hepatomegaly (5/12). All pediatric patients had decreased hemoglobin, an increased reticulocyte ratio, total bilirubin and direct bilirubin, a positive erythrocyte fragility test, and remarkable spherical erythrocytes in their peripheral blood. Seven cases had elevated aminotransferase; four cases had severely elevated aminotransferase and bilirubin; eight cases had biliary calculi; and two cases had a dilated biliary tract. Liver pathological examination showed mild damage to the liver cells (G1S1) in three pediatric cases. Five children had a total of six unreported mutations: SPTB gene c.2431_2450del, c.4974-2A > G, c.2575G > A, and exon 22-35 deletion; ANK1 gene: c.2379-2380delC; and c .6dupC. Children still had abnormal bilirubin levels following treatment. Two pediatric cases underwent splenectomy. Bilirubin and hemoglobin levels returned to normal after surgery. Conclusion:Children with HS may experience cholestasis, and those with poor treatment results may consider undergoing a splenectomy. Six new types of variants have expanded the HS gene mutation spectrum.

OBJECTIVE: To explore the genetic basis for a child with infantile liver failure syndrome type 2 (ILFS type 2). METHODS: Clinical features of the child were analyzed. Next generation sequencing was also carried out for him. RESULTS: The child was found to harbor compound heterozygous variants of the NBAS gene, which included a novel nonsense c.2746A>T (p.R916X, 1456) variant in exon 24 and a missense c.3596G>A (p.C1199Y) mutation in exon 31, which has been associated with ILFS type 2. The two variants were respectively inherited from his father and mother. CONCLUSION The compound heterozygous variants of c.3596G>A and c.2746A>T of the NBAS gene probably underlay the ILFS type 2 in this child.
Child ; Exons/genetics* ; Genetic Testing ; High-Throughput Nucleotide Sequencing ; Humans ; Liver Failure ; Male ; Mutation

Objective:To analyze the clinical characteristics of severe adenovirus pneumonia with bacterial infection in children, so as to provide clinical evidences for early diagnosis and reliable treatment.Methods:A total of 72 pediatric cases with severe adenovirus pneumonia admitted to Pediatric Intensive Care Unit at the First People′s Hospital of Chenzhou from January 2018 to August 2019 were included.The clinical features, laboratory and imaging data, efficacy of the treatments and prognosis were investigated retrospectively.Patients were divided into with bacterial infection group and without bacterial infection group.The clinical characteristics were analyzed.Results:Among the 72 children, there were 54 males and 18 females, aging from 3 months to 5 years, including 37cases with bacterial infection and 35 cases without bacterial infection.Compared with the group without bacterial infection, the group with bacterial infection had longer heat duration and hospital stay [12.0 (10.0, 18.5) days vs.10.0 (9.0, 12.0) days; 6.0(4.0, 7.0) days vs.11.0(6.5, 16.0) days, P<0.05], the incidences of diarrhea and hepatomegaly were higher[35.1% (13/37) vs.14.3%(5/35); 45.9%(17/37)vs.8.6%(3/35), P<0.05], the proportion of five lobes involved in lung imaging was higher [91.8% (34/37) vs. 57.1%(20/35), P<0.05]. The incidences of complications with respiratory failure, hemophagocytic lymphohistiocytosis, and bronchiolitis obliterans in the group with bacterial infection were significantly higher than those of without bacterial infection group ( P<0.05). Conclusion:For children under 2 years old age with severe adenovirus pneumonia, there are prolonged high fever and extensive pulmonary lesions.We should be highly alert to the combination of bacterial infection and timely anti-infection therapy.Children with severe adenovirus pneumonia with bacterial infection have severe clinical manifestations and many complications with respiratory failure, hemophagocytic lymphohistiocytosis, and bronchiolitis obliterans.

Objective:To analyze the distribution and antimicrobial resistance pattern of bacteria isolated from alveolar lavage fluid in pediatric patients with lower respiratory tract infection from 2016 to 2018.Methods:The alveolar lavage fluid of pediatric patients aged <18 years old with lower respiratory tract infection in ten hospitals from January 2016 to December 2018 were collected, and the pathogenic bacteria were cultured and isolated. The paper diffusion method or minimum inhibitory concentration method was used to conduct drug susceptibility tests for the isolated strains.The distribution of pathogenic bacteria and the source department of the strains were analyzed.Chi-sqare test was used for statistical analysis.Results:Of 1 271 isolates, 606 strains (47.7%) were gram-negative bacteria, 628 strains (49.4%) were gram-positive bacteria, and 37 strains (2.9%) were fungi. The common pathogens were Streptococcus pneumoniae (36.7%, 466/1 271), Acinetobacter baumannii (16.8%, 214/1 271), Staphylococcus aureus (12.7%, 162/1 271), Klebsiella pneumoniae (8.3%, 105/1 271), Haemophilus influenzae (7.4%, 94/1 271), Pseudomonas aeruginosa (6.2%, 79/1 271), Burkholderia cepacia (5.3%, 67/1 271) and Escherichia coli (3.7%, 47/1 271). The main pathogens in the intensive care unit (ICU) were gram-negative bacteria (80.1%, 428/534), among which Acinetobacter baumannii was the most common (3.7%, 199/534). The main pathogens in the non-ICU were gram-positive bacteria (70.8%, 522/737). The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 45.1%(23/51) in the ICU and 43.2% (48/111) in the non-ICU, respectively. The detection rates of penicillin-resistant Streptococcus pneumoniae (PRSP) were 10.9%(6/55) in the ICU and 18.5% (76/411) in the non-ICU, respectively. The detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP) were 57.3%(43/75) in the ICU and 33.3%(10/30) in the non-ICU, respectively. The detection rate of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the ICU was higher than that in the non-ICU (49.1%(27/55) vs 25.0%(6/24)), and the difference was statistically significant ( χ2=3.98, P=0.046). Eight strains (17.0%) of carbapenem-resistant Escherichia coli were detected, and 164 strains(76.6%) of carbapenem-resistant Acinetobacter baumannii were detected. Seventy-eight Haemophilus influenzae isolates were isolated from non-ICU, and the resistance rate to ampicillin was 57.4%(54/94). Burkholderia cepacia isolates were all isolated from ICU, and the resistance rates to piperacillin-tazobactam, levofloxacin, ciprofloxacin and compound sulfamethoxazole were 13.4%(9/67), 3.0%(2/67), 0(0/67) and 9.0%(6/67), respectively. Conclusions:Streptococcus pneumoniae is still the most common pathogen in pediatric patients with lower respiratory tract infection. Gram-negative bacilli are the main pathogens in pediatric patients with lower respiratory tract infection in the ICU. The dection rates of MRSA, PRSP and carbopenem-resistant gram-negative bacilli are high. And the resistance rate of Haemophilus influenzae to ampicillin is also high. The clinical empirical treatment should be determined according to different clinical background.

Neonatal acute liver failure is a rare and life-threatening disease in the neonatal period with complete or substantial loss of liver function, and liver cirrhosis can be identified after birth, with a high mortality rate. The main etiologies of this disease include autoimmune liver diseases during pregnancy, viral infection, blood diseases, metabolic diseases, ischemic injury, and other rare causes. At present, etiological treatment is the main treatment method, and liver transplantation is still an important option for patients with unknown etiology or no response to established treatments. Currently there are few studies on neonatal acute liver failure, so prospective studies are needed to investigate the influencing factors for treatment and prognosis.