OBJECTIVES: To investigate the incidence of extrauterine growth retardation (EUGR) and its risk factors in very preterm infants (VPIs) during hospitalization in China. METHODS: A prospective multicenter study was performed on the medical data of 2 514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020. According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge, the VPIs were classified to two groups: EUGR group (n=1 189) and non-EUGR (n=1 325). The clinical features were compared between the two groups, and the incidence of EUGR and risk factors for EUGR were examined. RESULTS: The incidence of EUGR was 47.30% (1 189/2 514) evaluated by weight. The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR (P<0.05), while small-for-gestational-age birth, prolonged time to the initiation of total enteral feeding, prolonged cumulative fasting time, lower breast milk intake before starting human milk fortifiers, prolonged time to the initiation of full fortified feeding, and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR (P<0.05). CONCLUSIONS It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible, strengthening breastfeeding, increasing calorie intake in the first week after birth, improving the velocity of weight gain, and preventing moderate-severe bronchopulmonary dysplasia in VPIs.
Female ; Fetal Growth Retardation ; Gestational Age ; Hospitalization ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Prospective Studies ; Risk Factors

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.
3-Oxo-5-alpha-Steroid 4-Dehydrogenase/genetics* ; Child ; China/epidemiology* ; Cryptorchidism/genetics* ; Disorders of Sex Development/genetics* ; Female ; Genital Diseases, Male ; Genotype ; Humans ; Hypospadias/genetics* ; Male ; Membrane Proteins/genetics* ; Penis/abnormalities* ; Phenotype ; Retrospective Studies ; Steroid 21-Hydroxylase/genetics*

Objective ， To investigate the role of serum chemokines and oxidative and antioxidant biomarkers in occupational （ silicosis） Methods silicosis hereinafter referred to as . A total of 58 patients with stage Ⅰ silicosis were selected as the - （ ）， research subjects using convenient sampling method. The serum levels of nuclear factor erythroid 2 related factor 2 Nrf2 -（ - ） - （ - - ） - heme oxygenase 1 HO 1 and 8 isoprstaglandin F2α 8 iso PGF2α were determined by enzyme linked immunesorbent assay. （ ） （ - ） The serum levels of lipid peroxide LPO and total antioxidant capacity TAOC were determined by chemistry colorimetric method. - - （ - ）， Luminex flow fluorescence technology was used to detect the serum levels of interferon γ inducible protein10 IP10 macrophage （ ）- ， - - （ ） inflammatory protein MIP 1α MIP1β and macrophagederived chemokine MDC . The above indicators were analyzed by factor Results - analysis. The information extraction rate of the original indicators of the nine biomarkers was 58.5%96.5%. Four common ， ， （ ） ， factors were extracted including Nrf2 antioxidant signaling pathway helper T cell Th 1 dominant chemotaxis the total ， ， ， ， ， oxidation/antioxidant balance and Th2 dominant chemotaxis whose variance contribution rates were 32.2% 19.1% 16.4% ， ， Conclusion - and 11.8% respectively and the cumulative variance contribution rate was 79.5%. Both the oxidant antioxidant ， disturbance and the dominance chemotaxis are involved in the occurrence and development of silicosis and the Nrf2 antioxidant signaling pathway plays the most critical role.

Abstract: Objective　To understand the distribution and drug resistance of bacteria in clinical blood culture specimens in Ningxia in recent years, and to provide a basis for the prevention and treatment of bloodstream infection diseases. 　　　Methods　The blood culture isolation bacteria and drug resistance of Ningxia bacterial resistance monitoring network hospitals from 2018 to 2020 were statistically analyzed by WHONET5.6 software. Results　In the past three years, a total of 6 757 strains of bacteria were isolated from blood samples, including 3 697 strains (54.7%) of gram-negative bacteria and 3 060 (45.3%) of gram-positive bacteria. Among the gram-negative bacteria, Escherichia coli (2 074 strains,30.7%), Klebsiella pneumoniae (696 strains), Pseudomonas aeruginosa (139 strains), and Acinetobacter baumannii (121 strains). Among the gram-positive bacteria, coagulase-negative Staphylococcus (1 691 strains,25.0%), Staphylococcus aureus (442 strains), Streptococcus spp. (431 strains), Enterococcus spp. (379 strains). Resistance to Escherichia coli and Klebsiella pneumoniae was 56.6% and 22.6% against third-generation cephalosporins, and resistance to carbapenems was 1.0% and 3.7%, respectively. Pseudomonas aeruginosa and Acinetobacter baumannii were resistant to carbapenems at 9.0%（12/139） and 80.7%（71/121）. Methicillin-resistant Staphylococcus aureus (MRSA) was detected at 26.8%, methicillin-resistant coagulase-negative Staphylococcus was detected at 70%, and no Staphylococcus bacteria resistant to vancomycin and linezolid were found. For three years, only 1 strain of vancomycin-resistant Enterococcus faecalis was detected, and no linezolid-resistant Staphylococcus and Enterococcus were detected. Conclusions　Ningxia clinical blood specimen isolates of Escherichia coli, coagulase-negative Staphylococcus, and Klebsiella pneumoniae are more common. Among them, the resistance rate of Escherichia coli and Klebsiella pneumoniae to the third generation of cephalosporins is relatively stable, and the resistance rate to carbapenems is low. Acinetobacter baumannii is highly resistant to carbapenems, and methicillin-resistant Staphylococcus aureus detection rates are on the rise and should be closely monitored.

The value of the "touching-bone" acupuncture technique in clinical application was explained through the investigation on the origin of the theory of the "touching-bone" acupuncture technique, the analysis on the characteristics of acupoint selection, the introduction of clinical characteristics and the discussion on the mechanism of acupuncture in treatment. The "touching-bone" acupuncture technique refers to deep needling method, originated from the short needling and needling of the ancient needling methodslisted in the . The target points are the reaction sites on meridian near to bone and the attachments of soft tissues on bone. During the needle insertion, the needle tip is thrust deeply to the bone or the needle body is closely attached to the bone so as to stimulate periosteum specifically. This needling technique contributes to the satisfactory effect on spasmodic, deep-located and intractable pain disorder, motor system diseases, mental diseases and cerebral diseases, etc. Hence, this acupuncture technique deserves to be promoted in clinical application and explored in research.
Acupuncture Therapy ; Meridians ; Needles

The analysis of Forsythia suspensa was performed on Waters Symmetry C₁₈ column( 4. 6 mm×250 mm,5 μm) and mobile phase was methanol( A)-0. 1% formic acid aqueous solution( B) with the elution gradient. Column temperature was maintained at 30℃,and the flow rate was 1. 0 m L·min^-1 with detection wavelength 265 nm. The HPLC-PDA fingerprint of F. suspensa was optimized.Chemical constituents in F. suspensa were analyzed by UFLC-Q-TOF-MS in positive and negative ion mode. The quality of 48 batches of F. suspensa from different habitats,processing methods and specifications was evaluated by similarity evaluation and cluster analysis.The 18 common peaks were confirmed. The similarity of F. suspensa from different habitats was more than 0. 98,and 56 chemical constituents were identified. Different processing methods had great influence on the quality of F. suspensa. Compared with boiled and direct drying,the quality of F. suspensa processed by sun-drying was obviously decreased. The similarity was about 0. 58. Different specifications of F. suspensa also had obvious distinction,and the similarity was about 0. 78. The effective components of grown F. suspensa,such as forsythoside A and phillyrin,were significantly reduced. The results of cluster analysis were basically consistent with the results of similarity evaluation. The establishment of fingerprint and the recognition of chemical pattern of F. suspensa can provide a more comprehensive reference for the quality control of herbs.
Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal/chemistry* ; Forsythia/chemistry* ; Quality Control

OBJECTIVETo detect atypical BCR/ABL mRNA transcript by real-time quantitative PCR in CML patients without e13a2/e14a2,e19a2 or e1a2 transcripts, and investigate its value of clinical application.

METHODSTwelve cases of CML with positive for t(9;22) translocation, but negative for common major and minor breakpoint cluster regions comfirmed by chromosome karyotyping or FISH analysis, were collected from July 2012 to December 2015. These 12 cases were then detected for b2a3(e13a3), b3a3(e14a3), e6a2, e8a2 and e1a3 fusion variants by real-time quantitative PCR.

RESULTSAmong 12 cases 4 variant transcripts were detected, including e1a3 in 1 case (8.33%), e8a2 in 2 cases (16.67%), b2a3 in 5 cases (41.67%) and b3a3 in 4 cases (33.33%), with total positivity of 100%, moreover b2a3 and b3a3 were predominant.

CONCLUSIONThe detecting atypical BCR/ABL mRNA transcripts by real-time quantitative PCR is suitable for the diagnosis of CML negative for P210, P190 and P230 by standard real-time PCR test, and this detection is still the standard and economic method for monitoring minimal residual disease in CML patients with variants of BCR/ABL fusion gene.

Objective To investigate the value of ultrasonography in the diagnosis and differential diagno-sis of lymphoma and stromal tumor of the small intestine. Methods The clinical characteristics and ultrasound findings of 36 patients with small intestine lymphoma and 69 patients with small intestine stromal tumor confirmed pathologically in Cancer Hospital of Chinese Academy of Medical Sciences between January 2009 and January 2016 were retrospectively analyzed and compared. Results There were statistically significant differences in echotexture,presence of echoless area,intratumoral gas,and ultrasonographic pattern between small intestine lymphoma and small intestine stromal tumor( all P ﹤0. 001 ),whereas no statistically significant difference in clinical characteristics,lesion size,contour,or lobulated mass. On ultrasound,small intestine lymphoma mainly demonstrated as infiltrative or mass-forming type,with homogeneous echotexture without cystic necrotic area;while small intestine stromal tumor demonstrated as mass-forming type with heterogeneous echotexture and cystic necrotic area. Conclusions Lymphoma and stromal tumor of the small intestine both have some characteristic ultrasound features,the difference between which may help in the diagnosis and differential diagnosis of these two conditions.

Obej ctiev To analyze the imaging characteristics of hepatic epithelioid hemangioendothelioma ( EHE) and their correlation with histopathological findings.Methods CT and MRI imaging and histopathological characteristics of five patients with hepatic EHE were retrospectively reviewed and the correlation of their imaging characteristics with pathological findings was analyzed.Results A total of 92 lesions were found in the 5 patients, all presenting with multiple nodules.All the 92 lesions were located within a 2-cm zone beneath the hepatic capsule, i.e., the shortest distance from the border of lesions to the hepatic capsule.28 of the 92 lesions showed the“capsular retraction” sign. 36 lesions were found in three patients receiving MRI .77.8%of the 36 lesions demonstrated the“halo” sign on a fat-suppression T2-weighted image, while 91.7%after contrast enhancement.A peripheral dark rim was found in 91.7%of the lesions on a fat-suppression T2-weighted image.In addition, 36.1%of the lesions showed slight internal or edge enhancement at the hepatobiliary phase.In the two patients receiving CT examination, 7 of 56 lesions demonstrated the“halo” sign.Conclusions Hepatic EHE may manifest as nodular lesions with predilection of peripheral subcapsular growth and nodular confluence, together with “halo” sign and “capsular retraction”.The peripheral dark rim on a fat-suppression T2-weighted image and slight enhancement at the hepatobiliary phase can help to improve the accuracy of diagnosis and differential diagnosis of this hepatic tumor.MRI is superior to CT imaging to depict their intra-lesional characteristics.