OBJECTIVES: To investigate the levels of physical growth and neurodevelopment in preterm infants at the corrected age of 18-24 months. METHODS: The physical growth data and neurodevelopment data of 484 preterm infants at corrected age of 18-24 months were prospectively collected by a post-discharge follow-up system for preterm infants. The infants were regularly followed up in Shenzhen Bao'an Maternal and Child Health Hospital Affiliated to Jinan University from April 2018 to December 2021. The neurodevelopment was evaluated by the Children Neuropsychological and Behavioral Scale-Revision 2016. A total of 219 full-term infants served as controls. The infants were divided into groups (extremely preterm, very preterm, moderate late preterm, and full-term) based on gestational age, and the groups were compared in the levels of physical growth and neurodevelopment. RESULTS: Except that the moderate preterm group had a higher length-for-age Z-score than the full-term group (P=0.038), there was no significant difference in physical growth indicators between the preterm groups and the full-term group (P>0.05). Each preterm group had a significantly lower total developmental quotient (DQ) than the full-term group (P<0.05). Except for the social behavior domain, the DQ of other domains in the extremely preterm and very preterm groups was significantly lower than that in the full-term group (P<0.05). The <32 weeks preterm group had a significantly higher incidence rate of global developmental delay than the full-term group (16.7% vs 6.4%, P=0.012), and the incidence rate of global developmental delay tended to increase with the reduction in gestational age (P=0.026). CONCLUSIONS Preterm infants can catch up with full-term infants in terms of physical growth at the corrected age of 18-24 months, but with a lower neurodevelopmental level than full-term infants. Neurodevelopment monitoring and early intervention should be taken seriously for preterm infants with a gestational age of <32 weeks.
Infant ; Child ; Infant, Newborn ; Humans ; Child, Preschool ; Infant, Premature ; Aftercare ; Patient Discharge ; Gestational Age

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
Adolescent ; Brain Abscess ; Child ; Child, Preschool ; Escherichia coli ; Female ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial/epidemiology* ; Retrospective Studies ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion ; beta-Lactamases

OBJECTIVES: To assess the growth of preterm infants up to a corrected age of 24 months, and to understand the growth trend and pattern of preterm infants. METHODS: A preterm infant follow-up database was established based on the Internet Plus follow-up system. A total of 3 188 preterm infants who were born from April 2018 to April 2021 were enrolled. Their length, weight, and head circumference were recorded at birth and at the corrected ages of 1, 3, 6, 12, 18, and 24 months. The preterm infants were grouped by perinatal factors. The growth curves of these infants were plotted and compared with the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standard and World Health Organization (WHO) standard. RESULTS: The weight, length, and head circumference curves of each group of preterm infants grouped by various perinatal factors all rose rapidly within the corrected age of 6 months, but the growth rate slowed down after the corrected age of 6 months. Based on the actual age for the groups of preterm infants with different gestational ages (<28 weeks, 28-31 CONCLUSIONS The physical growth rate of preterm infants is faster within the corrected age of 6 months, and the growth rate slows down after the corrected age of 6 months. Preterm infants with a smaller gestational age need longer time to catch up in weight and head circumference. More attention should be paid to the physical growth of extremely preterm infants, extremely low birth weight infants, and small-for-gestational-age infants.
Cephalometry ; Child, Preschool ; Female ; Gestational Age ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Small for Gestational Age ; Pregnancy

Objective: To investigate the safety and efficacy of ultrafiltration on diuretic sensitivity in heart failure patients with reduced ejection fraction and diuretic resistance. Methods: This was a single-center randomized controlled trial. A total of 148 heart failure patients with reduced ejection fraction admitted to the Hospital of Traditional Chinese Medicine of Xinjiang Uygur Autonomous Region from June 2010 to June 2020 were enrolled in this study, and these patients were randomly divided (ratio 1:1) into the ultrafiltration group (n=74) and the control group (n=74). All patients were treated with diuretics, cardiotonic, vasodilator and other comprehensive drugs according to relevant guidelines. After grouping, the patients in the control group were treated with standard treatment plan, while patients in the ultrafiltration group were treated with ultrafiltration on top of standard therapy. Diuretic drugs were discontinued during ultrafiltration, and intravenously furosemide (40 mg) was given immediately and 24 hours after the end of ultrafiltration. Clinical data including gender, age, complicated diseases, New York Heart Association (NYHA) function classification, etc. were collected. Effectiveness indicators include urine volume (the first 12-hour and 24-hour urine volume and the second 24-hour urine volume after using diuretic), body weight and dyspnea severity score. Safety indicators include systolic blood pressure, serum creatinine, serum Na⁺ concentration, blood K⁺ concentration and the number of deaths before and after intervention. Results: Two patients in the control group died due to worsening heart failure after randomization and were excluded in this study, 146 patients were finally analyzed (72 patients in the control group and 74 patients in the ultrafiltration group). There were 93 males, and the age was (68.3±11.2) years. There was no significant difference between patients in the ultrafiltration group and the control group in gender, age, body weight, course of disease, dyspnea severity score, NYHA function classification Ⅲ/Ⅳ, the proportion of patients with severe edema of both lower limbs, the proportion of patients with complicated diseases, and basic medication (all P>0.05). After using diuretics, the urine volume of the first 12-hour and 24-hour and the second 24-hour were significantly higher in the ultrafiltration group than in the control group (all P<0.05). Body weight decreased significantly after ultrafiltration treatment as compared with that before intervention in the ultrafiltration group (P<0.05). Compared with the control group, the dyspnea severity score was significantly improved in the ultrafiltration group (P<0.05). There was no significant difference in systolic blood pressure, serum creatinine, serum Na⁺ concentration, blood K⁺ concentration of patients between ultrafiltration group and control group before and after intervention (all P>0.05). During the clinical diagnosis and treatment, 2 male patients in the control group died, and the cause of death was aggravation of basic diseases complicated with acute heart failure and cardiogenic shock. There was no death in the ultrafiltration group, and there were no obvious clinical adverse events during and after ultrafiltration. Conclusion: Ultrafiltration therapy is safe and can improve diuretic sensitivity in heart failure patients with reduced ejection fraction and diuretic resistance.
Aged ; Diuretics/therapeutic use* ; Furosemide/therapeutic use* ; Heart Failure/drug therapy* ; Humans ; Male ; Middle Aged ; Stroke Volume ; Ultrafiltration

There are 400 thousand patients with long-term hemodialysis in China nowadays. Hemodialysis, as the most common alternative to renal replacement therapy, prolongs the life span of patients with end stage renal failure. However, there are still many complications of hemodialysis treatment. These complications reduce the quality of life of patients and may even endanger their life, and sometimes they are difficult to deal with. Classical prescriptions, commonly referred to as classical effective prescriptions in modern medicine, mainly indicating the formulas recorded in Treatise on Febrile Diseases and Synopsis of Golden Chamber, were relative to contemporary prescriptions emerging after Song and Yuan dynasties. Prescriptions corresponding to syndromes means one-to-one correspondence between syndromes and prescriptions, with many advantages and that is the key of clinical efficacy. Many complications of hemodialysis patients have typical clinical manifestations, which can match the syndromes corresponding to classical prescriptions, thus quickly relieving the symptoms of patients in clinical application. Six clinical cases of dialysis muscle spasm, disequilibrium syndrome, restless legs syndrome, uremic encephalopathy, post dialysis arrhythmia, and secondary hyperparathyroidism were used in this paper, to explore the intervention strategies for hemodialysis related complications.

Objective To evaluate the role of ultrasound for thyroid nodules with atypia of undetermined significance(AUS).Methods From January 2014 to December 2015,83 thyroid nodules with AUS diagnosed by ultrasound-guided fine-needle aspiration biopsy were collected from 1984 subjects. On the basis of ultrasonic features,each thyroid nodule was prospectively classified into one of three categories: low suspicion for malignancy,intermediate suspicion for malignancy,and high suspicion for malignancy. Results Among 83 lesions,19 lesions(22.9%) were confirmed malignant,8 lesions (9.6%)were benign,56 lesions (67.5%)had no abnormal changes during clinical follow-up. The nodules were solitary in 36 cases (43.4%)and multiple in 47 cases(56.6%).The maximum diameter was (1.2±0.7)cm. Based on the ultrasonic feature of 19 malignant cases,16 cases (84.2%) were classified as high suspicion for malignancy,2 cases(10.5%) as intermediate suspicion for malignancy,and 1 case(5.3%) for low suspicion for malignancy. Univariate and multivariate analyses revealed that the degree of malignancy of thyroid nodules was significantly associated with ultrasound image classification[OR=9.23(2.96-28.79),P=0.00],but not with age,gender,nodule number,and nodule size (all P>0.05).Conclusion Ultrasound diagnosis by using the present thyroid ultrasound classification system can be helpful for distinguishing malignant and benign AUS thyroid nodules.
Biopsy, Fine-Needle ; Humans ; Thyroid Gland ; diagnostic imaging ; Thyroid Neoplasms ; diagnostic imaging ; Thyroid Nodule ; diagnostic imaging ; Ultrasonography

Adult ; Female ; Humans ; Prednisone ; therapeutic use ; Sarcoidosis ; diagnosis ; Takayasu Arteritis ; diagnosis

Objective To explore the difference in clinicopathological characteristics between invasive mi -cropapillary carcinoma (IMPC) and invasive carcinoma of no special type (NST), and analyze its association with axillary lymph node metastasis .Methods The clinicopathological data of 92 IMPC cases treated within the period from August 2010 to August 2013 in Peking Union Medical College Hospital were retrospectively analyzed . From patients in the same period , 368 NST cases were randomly selected as control group .The difference in clin-icopathological characteristics between IMPC and NST were compared , and the factors associated with axillary lymph node metastasis were analyzed .Results There were significant differences in tumor size [ ( 2.9 ± 1.9) cm vs.(2.1 ±1.4) cm, P=0.001], lymph-vascular invasion rate (85.9% vs.6.0%, P<0.001), axillary lymph node metastatic rate (71.7%vs.47.3%, P<0.001), number of involved lymph node (8.2 ± 9.9 vs.2.9 ±5.7 , P<0.001 ) , progestogen receptor expression ( P=0.047 ) , human epidermal growth factor receptor-2 (HER-2) expression (P=0.009), Ki-67 index (P<0.001), TNM staging (P<0.001), and mo-lecular subtype ( P<0.001 ) between IMPC and NST .The axillary lymph node metastatic rates of tumor contai-ning ≤24%, 25%-49%, 50%-75% and ≥76% IMPC component were 73.9%, 56.3%, 72.2% and 77.1%, respectively .The axillary lymph node metastatic rate was not correlated with the percentage of IMPC component ( P=0.347 ) , but correlated with T-staging ( P=0.001 ) , HER-2 expression ( P=0.029 ) , molecu-lar subtype ( P=0.003 ) , P53 expression ( P=0.003 ) , and Ki-67 index ( P=0.045 ) .The axillary lymph node metastasis of NST was found correlated with T-staging ( P<0.001 ) , histological grade ( P =0.001 ) , lymph-vascular invasion ( P<0.001 ) , estrogen receptor αexpression ( P=0.007 ) , progestogen receptor expres-sion ( P=0.031 ) , HER-2 expression ( P=0.008 ) , and molecular subtype ( P<0.001 ) .Conclusions IMPC is a distinct variant of invasive breast carcinoma with a high propensity for lymph -vascular invasion and axillary lymph node involvement .IMPC and NST have different clinicopathological characteristics .The percentage of IMPC component does not correlate with axillary lymph node metastasis .Compared with NST , there are less clini-copathological determinants for axillary lymph node metastasis in IMPC .

OBJECTIVETo investigate the risk factors for anastomotic infectious complications after bowel resection in patients with Crohn disease.

METHODSClinical data of 124 patients with Crohn disease undergoing bowel resection between January 1990 and October 2012 were analyzed retrospectively. The risk factors were identified by χ(2) test and Logistic regression.

RESULTSFourteen patients (12.3%, 14/114) developed anastomotic infectious complications in the postoperative period, including anastomotic leak (n=7), intra-abdominal abscess (n=6), and enterocutaneous fistula (n=1). Crohn disease activity index (CDAI)>150 (OR=2.185, 95%CI:1.098-6.256, P=0.040), steroid usage (OR=2.674, 95%CI:1.118-8.786, P=0.027), and the presence of preoperative abscess/fistula (OR=3.447, 95%CI:1.254-10.462, P=0.014) were identified as independent risk factors of anastomotic infectious complications. In the absence of these 3 risk factors, the rate of anastomotic infectious complication was 5.7% (3/53), which increased to 11.4% (4/35) when one risk factor was present, 21.1% (4/19) when two risk factors were present, and 42.9% (3/7) when all the 3 risk factors were present.

CONCLUSIONSCDAI>150, steroid usage and preoperative abscess/fistula are associated with higher rates of anastomotic infectious complications following bowel resection for Crohn disease. A prudent management should be carried out if risk factors can not be eliminated preoperatively.

Abdominal Abscess ; pathology ; Adolescent ; Adult ; Aged ; Anastomosis, Surgical ; adverse effects ; Anastomotic Leak ; pathology ; Chi-Square Distribution ; Colectomy ; adverse effects ; Crohn Disease ; surgery ; Female ; Humans ; Intestinal Fistula ; pathology ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Steroids ; therapeutic use ; Surgical Wound Infection ; etiology ; surgery ; Young Adult

Objective To explore the biological and clinical significance of the double mutations of C1673T/C1799G in HBV C promoter (CP).Methods Totally 136 patients were enrolled,including 25 asymptomatic carriers (AsC),38 patients with chronic hepatitis B (CHB),24 patients with chronic severe hepatitis B (CSHB),36 cases with liver cirrhosis (LC) and 13 cases with hepatocellular carcinoma (HCC).HBV subgenotypes and mutations in CP of all samples were determined by nested-PCR and direct nucleotide sequence analysis.The C to T mutation at nucleotide 1673 and C to G at nucleotide 1799 were analyzed in different subgenotypes,and the relationships of C1673T/C1799G double mutations with HBV replication,the expression of HBeAg,and with the severity of liver disease after chronic HBV infection were studied.Results Of the 136 patients,110 were subgenotype Ba,1 was Bj,7 were C1,and 18 were C2.C1673T/C1799G double mutations in Ba were determined in 106 (96.4％) samples,which was significantly higher than in C1 (14.3％) and C2 (12.5％) subgenotype (P ＜ 0.0001).In contrast to nonmutation group,HBV DNA content in mutation group had no significant difference (P ＞ 0.05).The prevalence of the mutation was lower in HBeAg positive patients (71.4％) than in HBeAg negative patients (87.5 ％) (P ＜ 0.05).The frequencies of the double mutations were not significantly different among ASC,CHB,CSHB,LC and HCC groups (P ＞ 0.05).Conclusion In Ba subgenotype,double mutations of C1673T/C1799G is much popular than in C1 and C2; the mutation has no effect on HBV replication,and may not be associated with the outcome of chronic HBV infection.