Objective:To investigate the changes of mortality，causes of death，and cause-specific mortality rate（CMR）of hospitalized neonates in NICU of the First Affiliated Hospital of Sun Yat-sen University.Method:A retrospective study was performed to compare the mortality，cause of death，and CMR of hospitalized neonates in period Ⅰ（2005-2009），period Ⅱ（2010-2014）and period Ⅲ（2015-2020）.Result:The overall mortality of hospitalized neonates in NICU of our hospital was 0.51%（104/20 493）through 2005 to 2020. The mortality in period Ⅰ，Ⅱ and Ⅲ were 0.61%（48/7 855），0.43%（27/6 209），and 0.45%（29/6 429），respectively. Compared with period Ⅰ，the mortality of preterm infants decreased significantly in period Ⅱ（3.14% vs 1.24%， χ2=14.076， P<0.01）and in period Ⅲ（3.14% vs 0.90%， χ2=25.157， P<0.01）. Eighty-five（81.7%）neonates were premature，and ninety-one（89.2%）neonates had definite abnormal perinatal factors. The CMR of hospitalized neonates related to pulmonary hemorrhage，congenital anomalies，and NRDS were 1.22‰（25/20 493），0.93‰（19/20 493），and 0.59‰（12/20 493），respectively. The CMR of other causes were sepsis 0.44‰（9/20 493），extremely premature 0.34‰（7/20 493），and perinatal asphyxia 0.24‰（5/20 493），respectively. Compared with period Ⅰ，specific mortality of NRDS in period Ⅱ（1.27‰ vs 0.16‰， χ2=5.487， P=0.016）and period Ⅲ（1.27‰ vs 0.16‰， χ2=5.738， P=0.014）significantly decreased. The leading causes of neonatal death in period Ⅰ，period Ⅱ，and period Ⅲ were NRDS，pulmonary hemorrhage，and congenital anomalies，respectively.And 71.2%（74/104）of neonatal deaths occurred within 7 days after birth. Conclusion:The mortality of preterm infants and specific mortality of NRDS in NICU have significantly decreased over the past 16 years.Congenital anomalies and infections remain important causes of death，and further efforts are needed to improve perinatal care.

Objective To explore the clinical application of ultrasound-guided transabdominal villus and amniocentesis in the prenatal diagnosis of thalassemia,and to find a suitable method for the prenatal diagnosis of thalassemia in Qinzhou.Methods A total of 531 high-risk pregnant women with severe or intermediate thalassemia during single pregnancy who were treated in the Department of Medical Genetics and Prenatal Diagnosis,Qinzhou Maternal and Child Health Hospital from March 2021 to April 2022 were selected for the study.According to different sampling methods,they were divided into control group(amniocentesis,n=415)and study group(transabdominal villus puncture,n=116).The success rate,complication rate of the two groups were compared.Results The success rate of puncture in the control group was 100％,2 cases were aborted within 2 weeks after surgery,17 cases were diagnosed with severe alpha-thalassemia,10 cases with severe β-thalassemia and 64 cases with intermediate thalassemia,48 cases with moderate and severe thalassemia induced labor.The success rate of puncture in the research group was 100％,10 cases were diagnosed with severe alpha-thalassemia,4 cases with severe β-thalassemia and 17 cases with intermediate thalassemia,and 26 cases with moderate severe thalassemia were induced labor.There was no significant difference in puncture success rate and abortion rate between the two methods(P>0.05).Conclusion Both methods are safe and effective.Transabdominal villus sampling can detect fetal thalassemia in early pregnancy,and it is worth promoting and applying in clinical practice.

Objective: To analyze the burden indicators and trend predictions of eating disorders in Chinese adolescents aged 10-24 years from 1990 to 2019, so as to provide a reference for the prevention and control of eating disorders among adolescents. Methods: According to the latest data of the Global Burden of Disease Study(GBD) 2019 database classified by gender, age group and other indicators, the Joinpoint regression model and bayesian age period cohort model(BAPC) were used to analyze and predict the incidence rate, prevalence and disabilityadjusted life year (DALY) rate of eating disorders among Chinese adolescents aged 10 to 24 years old, and explore the trend of the disease burden of eating disorders in this population in the past three decades. Results: From 1990 to 2019, the overall crude incidence rate of eating disorders among adolescents in China increased from 278.93/105 to 422.27/105, and the crude incidence rate increased from 122.63/105 to 198.80/105, and the crude DALY rate increased from 26.67/105 to 43.50/105. In terms of gender, the standardized incidence rate, standardized prevalence rate and standardized DALY rate of eating disorders of boys and girls all showed an upward trend（boys：AAPC=1.52%，1.84%，1.86%，girls：AAPC=1.28%，1.74%，1.77%，P＜0.05）. The standardized incidence rate, standardized prevalence rate and standardized DALY rate of boys with eating disorders (54.97%, 68.88%, 69.75%) were higher than those of girls (44.26%, 64.48%, 65.56%), and the differences were statistically significant (χ2=201.45, 35.02, 34.55, P<0.05). In terms of age groups, the incidence rate of the 15-19yearold age group (524.10/105) was higher than that of other age groups (10-14yearold age:251.17/105, 20-24yearold age:476.49/105) (χ2=156.87, P<0.05), the prevalence rate of the 20-24yearold age group (278.67/105) and the DALY rate (60.83/105) were higher than those of other age groups (10-14yearold age:81.79/105,18.02/105, 15-19yearold age:221.81/105,48.59/105) (χ2=204.50,197.14, P<0.05). BAPC prediction model showed that in the future, the incidence rate of eating disorders among adolescents in China would still show an upward trend, but the prevalence rate and DALY rate would show a steady downward trend, which might reach 516.43/105, 188.41/105 and 41.23/105 respectively in 2030. Conclusions The burden of eating disorders among adolescents in China continues to increase, with boys and those aged 15-19 years being the key populations for prevention and treatment. All sectors of society should actively take relevant measures and pay attention to the prevention and treatment of adolescent eating disorders.

Objective:To compare the results of invasive prenatal diagnosis and preimplantation genetic testing (PGT) and explore the underlying mechanism.Methods:Clinical data of pregnant women undergoing PGT and invasive prenatal diagnosis at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2022 were collected. The results of PGT and invasive prenatal diagnosis were compared, and the outcomes of pregnancies were followed up. This study has been approved by the Medical Ethics Committee of the the Sixth Affiliated Hospital of Sun Yat-sen University (No. 2022SLYEC-491).Results:A total of 172 couples were included in this study, and 26 non-targeted variants were discovered upon prenatal diagnosis, including 10 cases (38.5%) by chromosomal karyotyping, 15 (57.7%) by chromosomal microarray analysis (CMA), and 1 (3.8%) by whole exome sequencing. The 10 karyotypic anomalies had included 6 chromosomal polymorphisms, 2 chromosomal mosaicisms, 1 paternally derived translocation, and 1 missed maternal chromosomal inversion. CMA has identified 15 copy number variations (CNVs), which included 11 microdeletions and microduplications, 3 loss of heterozygosity, and 1 low-level mosaicism of paternal uniparental disomy. One CNV was classified as pathogenic, and another one was likely pathogenic, whilst the remaining 13 were classified as variants of uncertain significance. Therefore, 8.7% of CNVs was detected by invasive prenatal diagnosis after PGT. 92.3% (24/26) of the non-targeted variants have been due to technological limitations of next-generation sequencing (NGS).Conclusion:Invasive prenatal diagnosis after PGT can detect non-targeted variants, which may further reduce the incidence of birth defects.

In traditional clinical teaching of impacted tooth extraction, there are problems including limited observation fields for students, insufficient doctor-patient communication training, inadequate clinical thinking development, and low levels of clinical participation. Based on the core elements of visualizing jaw structure with perspective, formulating clinical strategy, immersing in clinical participation, and cultivating the spirit of caregiving, we developed a virtual reality simulation teaching platform for the clinical decision analysis of impacted tooth extraction. The virtual simulation-based platform can create three different impacted tooth scenarios in 3D, which demonstrates the process of clinical decision analysis of impacted tooth extraction through virtuality-reality interaction, allowing students to immerse in the discovery, analysis, and resolution of the medical and humanistic problems in the process of impacted tooth extraction. The questionnaire survey showed that 81.36% (48/59) of the students believed that the software could improve their clinical thinking ability; 76.27% (45/59) of the students believed that it could help them master the basic process of impacted tooth extraction; and 62.71% (37/59) of the students believed that it could improve their skills of impacted tooth extraction. By providing immersive learning experience, constructive teaching design, and multi-dimensional teaching evaluation, the software achieved the goals of cultivating students' clinical thinking ability and professional literacy in oral and maxillofacial surgery.

Objective:Based on the data compilation and analysis of the disease burden of esophageal cancer attributed to alcohol consumption in China over the past three decades(1990-2019),this study aims to explore how to strengthen the formulation and management of public health policies to control the disease burden caused by this disease. Methods:Based on the data from the Global Burden of Disease(GBD)2019 study database,indicators such as mortality rate and disability-adjusted life years(DALYs)were used to assess the disease burden of esophageal cancer attributed to alcohol consumption in China.Joinpoint regression software and the age-period-cohort model were employed to analyze the trends in disease burden and mortality rates over time by age,period,and cohort.Bayesian age-period-cohort analysis was used to predict the mortality rates of esophageal cancer attributed to alcohol consumption in China from 2020 to 2030. Results:From 1990 to 2019,the number of deaths from esophageal cancer attributed to alcohol consumption increased from 33 800 cases to 61 900 cases,while the standardized mortality rate decreased from 3.95 per 100 000 to 3.04 per 100 000.DALYs increased from 934 000 person-years to 1 512 600 person-years,and the DALYs rate decreased from 101.36 per 100 000 to 71.39 per 100 000.In 2019,both the number of deaths and DALYs reached their peak in the age group of 65-69 years with 58 800 deaths and a standardized mortality rate of 6.21 per 100 000 for males,and 3 100 deaths and a standardized mortality rate of 0.31 per 100 000 for females.Both the mortality rates and the DALYs rates increased with age.The Joinpoint regression analysis showed that the average annual percentage change(AAPC)of mortality rates attributed to alcohol consumption-related esophageal cancer was-0.97%[95%confidence interval(CI):-1.2%--0.8%],with an AAPC of-2.32%(95%CI:-2.6%--2.1%)for females and-0.81%(95%CI:-1.0%-0.6%)for males.The age-period-cohort analysis of mortality rates attributed to alcohol consumption-related esophageal cancer showed a net drift of-1.301%(95%CI:-1.577%--1.025%,P＜0.05).It is predicted that the burden of esophageal cancer mortality attributed to alcohol consumption will steadily increase during the period of 2020-2030. Conclusion:Compared to the overall trend of esophageal cancer burden,the burden of esophageal cancer attributed to alcohol consumption is declining at a slower rate.The burden of the disease is higher in the male population than that in females,and higher in the middle-aged and elderly population compared to the younger population.It is expected that in the coming years,the burden of esophageal cancer mortality attributed to alcohol consumption in China will steadily increase,suggesting that while focusing on the intervention for males and the middle-aged and elderly population,relevant departments should also strengthen health education in the entire population,formulate public health policies,and raise awareness of early prevention and risk factors of esophageal cancer among residents.

Purpose To study the consistency of NTRK fu-sion gene in the thyroid carcinoma detected by four technology platforms:immunohistochemistry,DNA-based NGS,FISH and qRT-PCR.Methods NTRK fusion gene was detected by FISH,immunohistochemical(IHC),DNA-based NGS and qRT-PCR in a same group of 40 clinical cases(among them,31 cases were thyroid cancer samples).Results In a group of 31 thyroid cancer cases detected by four techniques,compared with FISH,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and total coincidence rate(TCR)of IHC was 100%(9/9),90.9%(20/22),81.8%(9/11),100%(20/20),93.5%(29/31),respectively.The PPV of IHC was poor.The sensitivity,specificity,PPV,NPV and TCR of DNA-based NGS was 44.4%(4/9),100%(22/22),100%(4/4),81.5%(22/27),83.9%(26/31),respectively,and the sensitivity was poor.The TCR of qRT-PCR was 100%(31/31).Compared with FISH,Kappa value of IHC,DNA-based NGS and qRT-PCR was 0.853,0.532 and 1.000,respectively.Of the 40 clinical cases,the concordance between qRT-PCR and FISH was observed for 39 samples,for the qRT-PCR assay did not cover the NTRK fusion type(LM-NA:exon4-NTRK1:exon10).Compared with FISH,the coinci-dence rate of qRT-PCR was highest.Conclusion The RNA-based assay of qRT-PCR does have the advantages of high sensi-tivity and high specificity,and may be an optimal scheme for routine clinical detection of NTRK fusion variation in thyroid cancer in pathology department.

Objective To investigate the effect of enteral nutritional support beginning at different time on aspiration events and immune function in the early post-traumatic (within 14 days) period in patients with severe traumatic brain injury.Methods From June, 2018, to February, 2021, 75 patients with acute traumatic brain injury admitted in the Department of Neurosurgery of the Second People's Hospital of Lianyungang were randomly divided into early feeding group (24 to 48 hours, n=35) and delayed feeding group (48 to 120 hours, n=40). The 14-day reflux rate, aspiration rate, incidence of aspiration pneumonia, immune indexes and complications were compared between two groups.Results There was no significant difference in the reflux rate, aspiration rate and the incidence of aspiration pneumonia between the two groups (P > 0.05). The levels of IgG, IgA, and complements C3 and C4 were significantly higher in the early feeding group than in the delayed feeding group (|t| > 1.720, P<0.001). The incidence of non-aspiratory lung infections was significantly lower in the early feeding group than in the delayed feeding group (χ2=4.728, P<0.05).Conclusion Initiating enteral nutrition within 24 to 48 hours after injury may preserve immune function and reduce the incidence of non-aspiratory lung infections in patients with severe traumatic brain injury.

Objective:To investigate the status of cognitive function in patients with acute cerebral infarction after intravenous thrombolysis, and analyze its influencing factors.Methods:From August 2020 to December 2021, convenience sampling was used to select 100 patients with cognitive impairment after intravenous thrombolysis for acute cerebral infarction admitted to the Department of Neurology of Shaoxing People's Hospital as the research object. The patients were followed up three months after intravenous thrombolysis. The Montreal Cognitive Assessment (MoCA) Scale and Self-made Cognitive Motor Training Compliance Scale and Exercise Training Compliance Scale were used to evaluate the cognitive function recovery and training compliance of the patients. Univariate analysis of variance and Logistic regression were used to analyze the influencing factors of cognitive function in patients with acute cerebral infarction after intravenous thrombolysis. A total of 100 questionnaires were distributed, 100 valid questionnaires were recovered with the recovery rate of 100%.Results:Three months after intravenous thrombolysis in patients with acute cerebral infarction, there were 85 patients with good cognitive function and 15 patients with abnormal cognitive function. Multivariate Logistic regression analysis showed that combined with hypertension, combined with abnormal glucose and lipid metabolism, National Institutes of Health Stroke Scale scores, thrombolysis time, infarct site, compliance with cognitive training and motor training were risk factors for cognitive function of patients with acute cerebral infarction after intravenous thrombolysis ( P<0.05) . Conclusions:Cognitive function of patients with acute cerebral infarction after intravenous thrombolysis is related to hypertension, abnormal glucose and lipid metabolism, NIHSS score, thrombolysis time, infarct location, and compliance cognitive with training, motor training. Ultra-early intravenous thrombolysis can protect cognitive function in patients with acute cerebral infarction. It is recommended to strengthen the prevention and control of the above risk factors and carry out early cognitive training and motor training to promote the early recovery of patients.

Objective:To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods:Through retrospective analysis, diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine, Quanzhou First Hospital East Street Branch Area, affiliated to Fujian Medical University between January to June 2021.Results:Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years, with various underlying diseases such as coronary heart disease, chronic heart failure, chronic obstructive pulmonary disease, etc.All patients had an established history of poultry exposure.These cases had high fever, cough, spitting, and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The disease progressed rapidly, with severe respiratory failure, acute kidney injury, and shock appearing soon, accompanied by different degrees of muscle injury, and damage to the heart, liver, blood coagulation, and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased: at 3, 5, 7 d after admission, the level of C reactive protein was 214.6(153.9-256.3)mg/L, 199.2(115.8-333.8)mg/L, 151.0(11.19-173.7)mg/L, respectively; and interleukin 6 level was 1 241.0(912.1-6822.0)ng/L, 779.1(451.2-7122.0)ng/L, 631.2(7.0-4 321.0)ng/L, respectively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground-glass shadows spreaded to both lungs, may accompany the miliary and nodular shadows, and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next-generation sequencing(mNGS), mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease, advanced age, underlying diseases, and timely diagnosis and effective treatment.Conclusions:The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age, more basic diseases such as chronic cardiopulmonary disease, smoking, and timely diagnosis and treatment.Generally, laboratory and imaging examinations have no diagnostic specificity, but mNGS is of great significance for early diagnosis, transition to target treatment and improvement of prognosis.