To enhance the learning stickiness, improve low completion rate of online teaching, and promote teaching quality has become the key to solve the contradiction in online teaching. In this paper, taking the teaching of biochemistry as example, based on the trigger mechanism, maintenance mechanism and migration mechanism of sticky learning, guided by the three-dimensional goal of "knowledge and skills, process and method, emotional attitude and values", the BOPPPS (bridge-in, objective, pre-assessment, participatory-learning, post-assessment, summary) teaching model was combined with online teaching. According to the interactive behavior in the course learning space, the Spearman rank correlation analysis was performed by SPSS 18.0 software to comprehensively evaluate the learning stickiness degree. The research has found that, due to its "micro but refined, compact structure and student-centered" characteristics, BOPPPS combining with online teaching can effectively make up for the time and space limitations of offline teaching and the excessively broad online teaching, bring benefits from the perspectives of "inclusion, attraction and production", promote students' active learning, and practically improve learning stickiness. The research provides a new idea for creating online "golden" courses.

Bronchopulmonary dysplasia(BPD)is a common chronic respiratory disease, with high mortality and poor long-term prognosis in surviving children, and there is currently no effective intervention.Breastfeeding reduces the incidence of BPD.These depend on a variety of bioactive substances in human breast milk, such as immunoglobulins, oligosaccharides, exosomes, etc.Exosomes are nano-like vesicle bodies secreted by cells, which participate in information transmission and functional regulation between cells.They have high affinity for the body and can tolerate digestion of gastrointestinal enzymes and stomach acid.These enable them to target lung, liver and other organs smoothly.They are expected to become a new method for the prevention and treatment of BPD.

Objective:To study the clinical features and high-risk factors of early-onset sepsis (EOS) in extremely preterm and super preterm infants.Methods:Retrospective study.Clinical data of extremely preterm and super preterm infants with the gestational age < 32 weeks were obtained from the clinical database of breast milk quality improvement registration in the Woman′s Hospital of Nanjing Medical University between January 2019 and December 2019.EOS cases were enrolled in the EOS group, and the remaining were enrolled in the control group.Risk factors for EOS, distribution of pathogenic bacteria, clinical features, complications, and outcomes between groups were analyzed.Measurement data were compared between the independent sample t-test.Counting data between groups were compared by the Chi- square test, corrected Chi- square test or Fisher′ s exact test.Multivariable Logistic regression model was used to analyze the risk factors of EOS in extremely and super preterm infants. Results:A total of 347 eligible neonates were recruited, including 22 neonates with EOS and 325 neonates without EOS.The incidence rate of EOS was 6.3%.Multivariate Logistic regression analysis showed that cesarean delivery was the protective factor for EOS ( OR=0.277, 95% CI: 0.091-0.847); while maternal prenatal infection ( OR=2.750, 95% CI: 1.053-2.908), fetid amniotic fluid ( OR=3.878, 95% CI: 1.344-11.187), chorioamnionitis ( OR=4.363, 95% CI: 1.552-12.236) and intubation ( OR=3.883, 95% CI: 1.133-13.306) were risk factors for EOS.A total of 22 strains of pathogenic bacteria were cultured in the EOS group, including 14 strains (63.6%) of Gram-positive bacteria, 7 strains (31.8%) of Gram-negative bacteria and 1 strain (4.6%) of fungus.The acute respiratory distress syndrome (54.5%), poor peripheral circulation perfusion (54.5%), mental depression (50.0%), and procalcitonin>0.5 mg/L (40.9%) were the main clinical features of EOS.Compared with the control group, extremely preterm and super preterm infants with EOS had a significantly higher rate of septic shock, disseminated intravascular coagulation, severe intraventricular hemorrhage (≥Ⅲ), acute respiratory distress syndrome (ARDS), and bronchopulmonary dysplasia( χ2=36.696, 33.255, 13.534, 95.455 and 3.886, respectively; all P<0.05). Conclusions:Maternal perinatal infection, odor amniotic fluid, chorioamnionitis and delivery room tracheal intubation are high-risk factors for preterm and super preterm infants with EOS, which can be prevented by cesarean section.Gram-positive cocci are the main pathogenic bacteria of EOS.ARDS and poor peripheral circulation perfusion are the main clinical manifestations of EOS, which increase the occurrence of severe intracranial hemorrhage and other complications.

Objective:To study the predictive value of total serum bilirubin (TSB) and the ratio of bilirubin to albumin (B/A) in neonatal acute bilirubin encephalopathy (ABE).Methods:Neonates with extremely severe hyperbilirubinemia (TSB≥425 μmol/L) treated in the Nanjing Maternal and Child Health Hospital, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Northwest Women and Children's Hospital, Yinchuan Maternal and Child Health Hospital and Liaocheng People's Hospital from March 2018 to August 2019 were selected as prospective subjects for this study. According to the score of brain injury induced by bilirubin, the subjects were divided into ABE group and non-ABE group, and the predictive value of TSB peak and B/A for neonatal ABE were analyzed.Results:A total of 194 infants with extremely severe hyperbilirubinemia were recruited in this study, including 20 in ABE group and 174 in non-ABE group. The peak value of bilirubin ranged from 427 to 979 μmol/L. The optimal critical values of TSB peak value and B/A for ABE prediction were 530 μmol/L and 9.48, respectively. The sensitivity and specificity of ABE prediction were 85.0% and 92.8% when combined with TSB peak and B/A values.Conclusions:TSB peak combined with B/A value can effectively identify neonatal ABE. When the TSB peak value was greater than 530 μmol/L and the B/A value was greater than 9.48, the neonates had a higher risk of neonatal ABE.

Breast milk contains a variety of bioactive components, which play a vital role in disease prevention and treatment.Among them, circular RNA(circRNA), which is a closed ring structure formed by covalent bonds, has aroused interest because of its conservation and stability.Pediatric researchers should attach importance to studies on circRNA in breast milk, as they may bring new inspiration for breast milk functions.In this article, characteristics and functions of circRNA in breast milk will be investigated, and its research and prospects will be discussed.

Objective:To study the risk factors, cerebral hemodynamics and clinical outcomes of extremely and very preterm infants with severe intraventricular hemorrhage (IVH).Methods:From January 2019 to December 2019, premature infants with gestational age (GA) <32 w admitted to our hospital were assigned into severe IVH group and non-severe IVH group. Risk factors for severe IVH were analyzed. According to clinical outcomes, severe IVH group was further assigned into improvement subgroup and no-improvement subgroup. Cerebral hemodynamic parameters were compared between the two groups.Results:A total of 346 eligible neonates were enrolled in this study. The incidence of severe IVH was 11.0% (38 cases). The incidences of Grade Ⅲ and Ⅳ IVH were 8.7% (30/346) and 2.3% (8/346), respectively. Multivariate logistic regression analysis showed that CA < 28 w ( OR=4.365, 95% CI 1.055~18.054), 5 min Apgar score ≤7 ( OR=8.749, 95% CI 2.214~36.042), chorioamnionitis ( OR=3.245, 95% CI 1.127～9.344), PaCO 2 fluctuation within 1 h >25 mmHg ( OR=7.728, 95% CI 1.738~80.907) and vasoactive drugs usage ( OR=10.883, 95% CI 3.746~31.621) were the risk factors of severe IVH. 20 cases in severe IVH group were improved at discharge and 12 cases showed no improvement at discharge. Improvement subgroup showed quicker reduction of the middle cerebral artery flow resistance and faster recovery of the mean flow velocity than the no-improvement subgroup. Conclusions:GA <28 w, 5 min Apgar score ≤7, chorioamnionitis, PaCO 2 fluctuation within 1 h >25 mmHg and vasoactive drugs usage are risk factors of severe IVH in extremely and very preterm infants. Cerebral hemodynamic monitoring may provide initial assessment for the clinical outcomes for severe IVH.

The initiation of lactation is the critical initial event contributing to breastfeeding. It is of great significance for maternal lactation and neonatal access to breast milk. However, various factors limit the successful initiation of lactation and increase the risk of poor neonatal prognosis. We provide an overview of the mechanism, significance, method, time, and factors that influence lactation initiation behavior, and summarize related guidelines aiming to gain more insight into the lactation initiation behavior to promote maternal lactation and improve neonatal prognosis.

Objective:To evaluate the outcomes of cardiopulmonary resuscitation in the delivery room (DR-CPR) at birth for very/extremely low birth weight infants (VLBWI/ELBWI).Method:PubMed, Embase, Cochrane Library, CNKI, VIP database and Wanfang database were searched. The search time limit is from the establishment of the database to October 26, 2020. Search and screen all the literature on the short-term and long-term outcomes of VLBWI/ELBWI who require DR-CPR and conduct quality evaluations. Review Manager 5.3 software was used to perform the Meta analysis. Egger's test in Stata Software 15.0 was used to draw a funnel plot and validate publication bias.Result:A total of 16 studies were included, all in English. 5 661 VLBWI/ELBWI received DR-CPR, and 73 438 VLBWI/ELBWI did not receive DR-CPR. The Meta analysis showed: DR-CPR for VLBWI/ELBWI was associated with an increased risk of mortality ( RR=2.30, 95% CI 1.89~2.82, P<0.05), grade 3 or 4 intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) ( RR=1.92, 95% CI 1.56~2.36, P<0.05),bronchopulmonary dysplasia (BPD) ( RR=1.18,95% CI 1.04~1.33, P<0.05), neurodevelopmental impairment (NDI) ( RR=1.25, 95% CI 1.14~1.38, P<0.05). However, it did not increase the risk of retinopathy of prematurity (>grade 2)( RR=1.31, 95% CI 0.96~1.79, P=0.09). The ELBWI was analyzed in subgroups, and the results were consistent with the overall results. Conclusion:CPR at birth for VLBWI/ELBWI was associated with higher risk of mortality, IVH (grade 3 or 4) or PVL, BPD, NDI.

Objective:To explore the value of laparoscopic and endoscopic cooperative surgery with the patient lying on supine position under general anesthesia in the operation of type I Mirizzi syndrome with choledocholithiasis.Methods:From Jan 2018 to Jan 2020, 53 cases of Mirizzi syndrome with choledocholithiasis undergoing laparoscopic and endoscopic cooperative surgery (preLC+ ERCP+ EST) at the Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed.Results:53 patients successfully underwent LC without conversion to open surgery, and 2 patients failed in ERCP + EST attempt, with a success rate of 96.2%. One patient developed pancreas pseudocyst as a result of post-operative hemorrhagic necrotizing pancreatitis. Two patients suffered from chronic pancreatitis. Three patients complaining postoperative upper abdominal discomfort were finally diagnosed as stump cystic duct inflammation by MRCP, and no abnormalities were found in the follow-up of the remaining cases.Conclusion:Laparoscopic and endoscopic cooperative surgery in the treatment of patients with type I Mirizzi syndrome combined with choledocholithiasis is minimally invasive and effective.

Objective:To investigate the current situation of human milk (HM) feeding in hospitalized very low and extremely low birth weight infants.Methods:The study retrospectively extracted the data of 601 infants with birth weight <1 500 g, and admitted within 24 hours after birth to the Neonatal Intensive Care Unit of Nanjing Maternity and Child Health Care Hospital from January 2016 to December 2018. The infants were grouped into exclusive mother′s-own-milk (MOM) group, donor human milk (DHM) group (partial or none MOM), and mixed (HM and formula) feeding group according to the feeding strategy. Qualitative and quantitative variables in the three groups were compared with One-way ANOVA, Kruskal-Wallis test, Chi-square test or Fisher exact test. Kappa and McNemar test were used for consistency testing.Results:Among the 601 infants (309 boys and 292 girls), 6 (1.0%) infants had never been fed with MOM. The gestational age and birth weight were (29.3±1.9) weeks and 1 260(1 115, 1 400) g in 601 infants. A total of 8 (1.3%) infants were grouped into MOM group, 542 (90.2%) were grouped into DHM group, and 51 (8.5%) were grouped into mixed feeding group. The percentage of enteral feedings with MOM in the stage of hospitalization 1-7 d, 8-14 d and 15-28 d were 73.6% (42.9%, 86.7%), 97.5% (78.6%, 100.0%) and 99.3% (93.0%, 100.0%), respectively ( H=414.95, P<0.01), and the pairwise comparison suggested that the stage of hospitalization 1-7 d was the lowest (adjusted both P<0.05). The average weight adjusted daily dose of MOM were 9.7 (4.3, 18.2), 59.1 (26.5, 93.5) and 116.0 (60.3, 142.6) ml/(kg·d) in the stage of hospitalization 1-7 d, 8-14 d and 15-28 d, respectively ( H=759.75, P<0.01), and the pairwise comparison suggested that the stage of hospitalization 1-7 d was the lowest (adjusted both P<0.05). The weight adjusted daily dose of MOM in exclusive MOM group, DHM and Mixed feeding group were 95.2 (40.0, 117.2), 82.9(53.6, 103.1) and 55.7 (16.6, 97.5) ml/(kg·d), respectively ( H=10.78, P=0.005).Additionally, the percentage and weight adjusted daily dose of MOM showed a general consistency of 0.703 ( P>0.05, Kappa=0.408). Conclusions:The rate of exclusive MOM feeding is low, especially during the first 7 days of hospitalization. The percentage of total enteral feedings with MOM and the average weight adjusted daily dose of MOM can well evaluate the situation of HM feeding during hospitalization quantitively.