简介：AbstractSepsis remains a significant cause of neonatal morbidity and mortality in China. A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally. Literature cited in this review was retrieved from PubMed using the keywords "neonatal sepsis," "early-onset (EOS)" and "late-onset (LOS)" in English, with the focus set on population-based studies. This review provides an updated summary regarding the epidemiology, pathogen profile, infectious work-up, and empirical treatment of neonatal sepsis within and beyond China. The incidence of neonatal EOS and the proportion of Group B Streptococcus (GBS) within pathogens causing EOS in China seem to differ from those in developed countries, possibly due to different population characteristics and intrapartum/postnatal health care strategies. Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable. The pathogen profile of LOS in China was shown to be similar to other countries. However, viruses as potential pathogens of neonatal LOS have been underappreciated. Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections. This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution. A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis. Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.

简介：AbstractImportance:Effective screening strategies for early-onset neonatal sepsis (EONS) have the potential to reduce high volume parenteral antibiotics (PAb) usage in neonates.Objective:To compare management decisions for EONS, between CG149 National Institute for Health and Care Excellence (NICE) guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator (SRC) in a level 2 neonatal unit at a district general hospital (DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS, neonatal clinical examination findings, and microbial culture results for all neonates born at ≥34 weeks’ gestation between February and July 2019, who were (1) managed according to CG149-NICE guidelines or (2) received PAb within 72 h following birth at a DGH in Winchester, UK. SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period. Of these, 19 (31.7%) met SRC criteria for antibiotics; 20 (33.3%) met the criteria for enhanced observations and none had culture-proven sepsis. Based on SRC projections, neonates with '≥1 NICE clinical indicator and ≥1 risk factor’ were most likely to have a sepsis risk score (SRS) >3. Birth below 37 weeks’ gestation (risk ratio [RR] = 2.31, 95% confidence interval [CI]: 1.02–5.22) and prolonged rupture of membranes (RR = 3.14, 95% CI: 1.16–8.48) increased the risk of an SRS >3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68% in term and near-term neonates in level 2 neonatal units.

简介：AbstractObjective:To investigate the effects of vitrification on the expression of the imprinted gene Snrpn in neonatal placental tissue.Methods:Neonatal placental tissue was collected from women with natural pregnancy (control group) and from women in assisted reproductive technology (ART) pregnancy group, following fresh and vitrified embryo transfer (fresh group and vitrified group, respectively). Snrpn mRNA expression and SNRPN protein levels in placental tissue from these three groups were assessed by real-time reverse transcription polymerase chain reaction and Western blot, respectively. DNA methylation in the Snrpn promoter region was analyzed by bisulfite-pyrosequencing.Results:The expression of Snrpn mRNA and SNRPN protein was found to be higher in placental tissue from the fresh and vitrified ART groups, compared to the control group. There was no significant difference in SNRPN gene or protein expression between the fresh and vitrified groups. DNA methylation at the Snrpn promoter region was not significantly different between these three groups.Conclusions:Human ART may alter the transcriptional expression and protein levels of the imprinted gene Snrpn. However, compared to other ART methods, vitrification may not aggravate or reduce this effect. Moreover, the altered expression of Snrpn is likely not directly related to DNA methylation of the Snrpn promoter region.

简介：ObjectiveTocharacterizemicroRNA(miRNA)expressionprofileinmicrodissectedauditoryepitheliafromtheCorti'sOrganinnewbornandadultrats.MethodsTheTaqManMicroRNAArrayswereusedtoidentifyexpressionofmicroRNAinthenewbornandadultgroups.GOanalysiswasappliedtoanalyzethemainfunctionofthedifferentialexpressiongenesaccordingtotheGeneOntologywhichisthekeyfunctionalclassificationofNCBI.Similarly,PathwayanalysiswasusedtofindoutthesignificantpathwayofthedifferentialgenesaccordingtoKEGG,BiocartaandReatome.ResultsIncreasedexpressionwasseenin16miRNAsinmatureratcomparedtonewbornrats,withincreasedfoldingrangingfrom17to600folds.Expressionlevelsin2miRNAswerereducedinmaturerats,namelyrno-miR-29candrno-miR-29a.Thehigh-enrichmentGOstargetedbyover-expressedmiRNAswerenegativeregulationofepithelialcelldifferentiation,common-partnerSMADproteinphosphorylation,mesenchymal-epithelialcellsignaling,regulationoftransforminggrowthfactorbeta2production,etc.FunctionalanalysisofmiRNAsbyKEGGrevealedthat19signaltransductionpathwayswereupregulatedand14weredownregulated.ConclusionsThedifferenceinmiRNAexpressionpatternsintheorganofCortibetweenneonatalandadultratsmaybecloselyrelatedtomaturationoftheorganofCortiandlossofproliferativecapacityofinnerearhaircells,andTGFβsignalingmayplayanimportantroleinhaircellsregeneration.

简介：MaleWistar7-day-oldratswereinjectedwith40mg/kgketamineintraperitoneally,followedbythreeadditionalinjectionsof20mg/kgketamineeachuponrestorationoftherightingreflex.Neonatalratsinjectedwithequivalentvolumesofsalineservedascontrols.Hippocampalsampleswerecollectedat1,7or14daysfollowingadministration.Electronmicroscopyshowedthatneuronalstructurechangednoticeablyfollowingketaminetreatment.Specifically,microtubularstructurebecameirregularanddisorganized.Quantitativerealtime-PCRrevealedthatphosphorylatedtaumRNAwasupregulatedafterketamine.Westernblotanalysisdemonstratedthatphosphorylatedtaulevelsatserine396initiallydecreasedat1dayafterketamineinjection,andthengraduallyreturnedtocontrolvalues.At14daysafterinjection,levelsofphosphorylatedtauwerehigherintheketaminegroupthaninthecontrolgroup.Tauproteinphosphorylatedatserine404significantlyincreasedafterketamineinjection,andthengraduallydecreasedwithtime.However,thelevelsoftauproteinatserine404weresignificantlygreaterintheketaminegroupthaninthecontrolgroupuntil14days.ThepresentresultsindicatethatketamineinducesanincreaseofphosphorylatedtaumRNAandexcessivephosphorylationoftauproteinatserine404,causingdisruptionofmicrotubulesintheneonatalrathippocampusandpotentiallyresultingindamagetohippocampalneurons.

简介：AbstractObjective:To evaluate the agreement and reliability of intrapartum nonreasurring cardiotocography (CTG) interpretation and prediction of neonatal acidemia by obstetricians working in different centers.Methods:A retrospective cohort study involving two tertiary hospitals (The First Affiliated Hospital of Sun Yat-sen University and Perking University Third Hospital) was conducted between 30th September 2018 and 1st April 2019. Six obstetricians from two hospitals with three levels of experience (junior, medium, and senior) reviewed 100 nonreassuring fetal heart rate (FHR) tracings from 1 hour before the onset of abnormalities until delivery. Each reviewer determined the FHR pattern, the baseline, variability, and presence of acceleration, deceleration, sinusoidal pattern, and predicted whether neonatal acidemia and abnormal umbilical arterial pH < 7.1 would occur. Inter-observer agreement was assessed using the proportions of agreement (Pa) and the proportion of specific agreement (Pa for each category). Reliability was evaluated with the kappa statistic (k-Light’s kappa for n raters) and Gwet’s AC1 statistic.Results:Good inter-observer agreement was found in evaluation of most variables (Pa>0.5), with the exception of early deceleration (Pa= 0.39, 95% confidence interval (CI): 0.36,0.43). Reliability was also good among most variables (AC1 > 0.40), except for acceleration, early deceleration, and prediction of neonatal acidemia (AC1 = 0.17, 0.10, and 0.25, respectively). There were no statistically significant differences among the three groups, except in the identification of accelerations (Pa = 0.89, 95% CI: 0.83,0.95; Pa= 0.50, 95% CI: 0.41,0.60, and Pa= 0.35, 95% CI: 0.25,0.43 in junior, medium and senior groups, respectively) and the prediction of neonatal acidemia (Pa= 0.52, 0.52, and 0.62 in junior, medium and senior groups, respectively), where agreement was highest and lowest in the junior-level group, respectively. The accuracy and sensitivity of the prediction for umbilical artery pH < 7.1 were similar among the three groups, but the specificity was higher in the senior groups (93.68% vs. 92.53% vs. 98.85% in junior, medium and senior groups, P= 0.015).Conclusion:Although we found a good inter-observer agreement in the evaluation of the most basic CTG features and FHR category statistically, it was insufficient to meet the clinical requirements for "no objection" interpretation for FHR tracings. Further specialized training is needed for standardized interpretation of intrapartum FHR tracings.

简介：Accordingtothemostrecentepidemiologicaldata,theprevalenceofhypertensionrangedfromabout25%inChineselivingeitherinthemainlandorinTaiwanandKoreans,toapproximately40%inMongolians.Thecontrolrateofhypertensionwasabout35%inKoreansandJapanese,24%inMongolians,andlessthan10%inChinese.Fourplacebo-controlledtrialsinChinaunequivocallyprovedthatantihypertensivetherapymaypreventstrokeandothercardiovascularcomplicationsinhypertensionorpatientswithahistoryofstrokeortransientischemicattack.Fouractively-controlledtrialsinJapandidnotshowsignificantdifferencebetweenvariousclassesorcombinationsofantihypertensivedrugs.TwotrialsthatcomparedintensivewithlessintensivebloodpressurecontrolinelderlyJapanesehypertensivepatientsdidnotshowfurtherbenefitofcontrollingsystolicbloodpressuretoalevelbelow140mmHgincomparisonwithbloodpressurecontroltoalevelof140mmHgorabove.Thesetrialsthatcomparedvariousclassesofantihypertensivedrugsorintensivewithlessintensivebloodpressurecontroloftenhadsmallsamplesizeandhenceinadequatepowertodetectmodestormoderatebenefit.ThereisstillaneedforhighqualityoutcometrialdatainEastAsians.

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简介：AbstractPurpose:Fingertip injuries are common in industrial production activities as well as in domestic work. Loss of pulp hampers daily life activities. Functional and aesthetic aspects are important in fingertip reconstruction. The bone is usually exposed along with soft tissue loss. Therefore to reconstruct the pulp flap with adequate bulk is required.Methods:We reported a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger. In all cases, laterally based thenar flap was chosen. The flap donor site was closed primarily in most of cases, while 4 patients required skin graft. The flap was detached between 2-3 weeks. Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint. The aesthetic outcome was assessed through questionnaire. The results were analyzed using the unpaired t-test (SPSS version 21).Results:Partial necrosis occurred in 2 cases while rest of flaps survived successfully. Static 2-point discrimination ranged from 6-10 mm, mean 8.6 mm; and dynamic 2-point discrimination ranged from 8-10 mm, mean 8.9 mm. The mean satisfaction score was (4.0 ± 0.55).Conclusion:Thenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.

简介：客观：调查创伤的有三个尖头的不足的外科的治疗的最佳的时间和过程。方法：从1984年5月到2004年9月，八个病人为创伤的有三个尖头的阀门不足经历了操作。所有病人，男性，从7～67年变老[中部：38年，意味着：（38。5±18。1)年]。在损伤和操作之间的间隔从1个月到20年[中部：19个月，意味着：(52.5±80.3)月)]。Inseven病人，有三个尖头的不足被归因在三个病人包括车辆事故弄钝胸损伤，另外的病人是一处stab创伤。诊断是证实的byechocardiography。在病人的外科手术前的心脏的功能作为纽约HeartAssociation(NYHA)班Ⅱ-Ⅳ被分类。在手术期间，有三个尖头的阀门的前面的传单完全或部分在所有病人由于索的破裂被乱摆。氏族的传单的索的破裂在一个病人被发现。前面的传单在二个病人被穿孔。Septalleaflet被缩回并且支持者到在二个病人的室的中隔。阀门修理为所有病人被打算。最后，阀门修理在3个病人成功地被执行，有三个尖头的代替在5个病人被执行。结果：没有早或迟了的死亡发生了。与follow-upthrough为7-129月的临床的表明和回响心动描记法[中部：39个月，平均数:(53.4±42.8)月]，所有病人作为NYHA班Ⅰ被分类，没有任何changes.Conclusions：创伤的有三个尖头的不足的令人满意的治疗能被外科的治疗获得。更早的外科可以增加有三个尖头的阀门修理的可行性并且阻止恰好室的功能的恶化。

简介：lObjectiveTalar身体破裂是稀罕的并且有差的处理结果。学习是报导关上的talardomefractures.MethodsEight的长期的外科的治疗结果的这的目的关上了talar身体破裂，在我们的水平与小碎片cancellous螺丝钉或Herbert螺丝钉由开的减小和内部固定对待我损伤中心回顾地被分析。脚(antero以后、侧面、倾斜的看法)和脚关节的外科手术前、手术后的拍(antero以后，侧面并且榫眼看法)被获得。病人被跟随在上面放射学地并且机能上地(脚功能索引，FFI)在3以后，星期，6个星期，3个月，6个月然后annually.ResultsThere是五压碎破裂并且三砍破裂(二sagittal砍并且一个花冠砍)，与5年的平均后续。没有早复杂并发症在这些病人被注意。迟了的复杂并发症在四个病人在talar身体的六个病人和osteonecrosis包括了subtalar/ankle关节的osteoarthrosis。在功能的评价以后，在5年以后的吝啬的FFI是104.63个点，更坏的结果在压碎损害和花冠被注意砍破裂。Sagittal砍破裂有对通过手术对待的talar身体破裂随后的复杂并发症是的好功能、放射学的outcome.ConclusionsLate不可避免尽管准确减小和僵硬固定被完成，因此，病人们应当关于不利结果被建议。尽管压碎和花冠砍，破裂有差的结果，sagittal损害在长期的评估上有好预后。

简介：ObjectivesPercutaneousballoonmitralvalvuloplasty(PBMV)isonewaytoimprovetherheumaticmitralstenosis.Howdoestheprocedureworkingravidaandfetusisnotveryclear.WeanalyzedtheeffectsandsafetyofPBMVoperationonpregnantpatientswithsevererheumaticmitralstenosis.MethodsEightpregnantpatientssufferingfromseveremitralstenosisunderwentfacilitatedPBMVoperationwithInoueballoon,andwerefollowedupfor(2.0±1.1)years.Contentsincludedoutcomeofpregnancy,infantgrowth,hemodynamics,echocardiography,cardiacfunction,mitralvalvesreplacementorrepeatvalvuloplasty.ResultsMitralvalvearea(MVA)before,oneweekandoneyearafterfacilitatedPBMVwere(0.84±0.21)cm2,(1.69±0.23)cm2and(1.51±0.24)cm2respectively.Thetransmitralpressuregradientdroppedfrom(22.1±4.7)mmHgto(9.9±3.1)mmHg(P<0.001)(1mmHg=0.133kPa).AfterfacilitatedPBMV,allpatientsshowedremarkableimmediatesymptomaticandhemodynamicimprovementwithoutseveremitralregurgitation.AllofthesepatientscouldmaintainNewYorkheartassociation(NYHA)ⅠorⅡfor(2.0±1.1)yearsaftertheoperation.TwopatientsdemandedinducedabortionconcerningabouttheteratogeniceffectofX-rayonfetus.Alltheothersixpatientscontinuedtheirgestationandhadfull-termcesareansectionwithoutcomplications.Theirnewbornsdevelopedhealthyandnormallytillnow.ConclusionsFacilitatedPBMVisafeasible,safeandeffectivedeviceforselectedpregnantpatientswithmitralstenosis.Theoperationiswelltoleratedbythefetus.

简介：AbstractFamily integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy; important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi-disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond.

简介：AbstractImportance:Parent-infant closeness and active parent participation in neonatal care are important for parent and infant health.Objective:To give an overview of current neonatal settings and gain an in-depth understanding of facilitators and barriers to parent-infant closeness, zero-separation, in 19 countries.Methods:Neonatal intensive care unit (NICU) professionals, representing 45 NICUs from a range of geographic regions in Europe and Canada, were purposefully selected and interviewed June–December 2018. Thematic analysis was conducted to identify, analyze and report patterns (themes) for parent-infant closeness across the entire series of interviews.Results:Parent-infant separation during infant and/or maternity care is very common (42/45 units, 93%), despite the implementation of family integrated care (FICare) practices, including parent participation in medical rounds (17/45, 38%), structured education sessions for parents (16/45, 36%) and structured training for healthcare professionals (22/45, 49%). NICU professionals encountered four main themes with facilitators and barriers for parent-infant closeness on and between the hospital, unit, staff, and family level: Culture (jointly held characteristics, values, thinking and behaviors about parental presence and participation in the unit), Collaboration (the act of working together between and within different levels), Capacities (resources and policies), and Coaching (education to acquire and transfer knowledge and skills).Interpretation:Implementing parent-infant closeness in the NICU is still challenging for healthcare professionals. Further optimization in neonatal care towards zero-separation and parent-infant closeness can be achieved by enforcing the 'four Cs for Closeness’: Culture, Collaboration, Capacities, and Coaching.

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简介：AbstractPurpose:Traumatic brain injury (TBI) generally causes mortality and disability, particularly in children. Machine learning (ML) is a computer algorithm, applied as a clinical prediction tool. The present study aims to assess the predictability of ML for the functional outcomes of pediatric TBI.Methods:A retrospective cohort study was performed targeting children with TBI who were admitted to the trauma center of southern Thailand between January 2009 and July 2020. The patient was excluded if he/she (1) did not undergo a CT scan of the brain, (2) died within the first 24 h, (3) had unavailable complete medical records during admission, or (4) was unable to provide updated outcomes. Clinical and radiologic characteristics were collected such as vital signs, Glasgow coma scale score, and characteristics of intracranial injuries. The functional outcome was assessed using the King's Outcome Scale for Childhood Head Injury, which was thus dichotomized into favourable outcomes and unfavourable outcomes: good recovery and moderate disability were categorized as the former, whereas death, vegetative state, and severe disability were categorized as the latter. The prognostic factors were estimated using traditional binary logistic regression. By data splitting, 70% of data were used for training the ML models and the remaining 30% were used for testing the ML models. The supervised algorithms including support vector machines, neural networks, random forest, logistic regression, naive Bayes and k-nearest neighbor were performed for training of the ML models. Therefore, the ML models were tested for the predictive performances by the testing datasets.Results:There were 828 patients in the cohort. The median age was 72 months (interquartile range 104.7 months, range 2-179 months). Road traffic accident was the most common mechanism of injury, accounting for 68.7%. At hospital discharge, favourable outcomes were achieved in 97.0% of patients, while the mortality rate was 2.2%. Glasgow coma scale score, hypotension, pupillary light reflex, and subarachnoid haemorrhage were associated with TBI outcomes following traditional binary logistic regression; hence, the 4 prognostic factors were used for building ML models and testing performance. The support vector machine model had the best performance for predicting pediatric TBI outcomes: sensitivity 0.95, specificity 0.60, positive predicted value 0.99, negative predictive value 1.0; accuracy 0.94, and area under the receiver operating characteristic curve 0.78.Conclusion:The ML algorithms of the present study have a high sensitivity; therefore they have the potential to be screening tools for predicting functional outcomes and counselling prognosis in general practice of pediatric TBIs.

简介：男富饶上的精索静脉曲张修理的效果仍然保持争论。它将对有用决定了哪个人将从精索静脉曲张修理有益于大多数，并且在那些个人指向修理努力。为精索静脉曲张修理的预示的因素上的文学的详细评论用PubMedNLM数据库被执行。我们发现postvaricocelectomy精液参数的最好的预言者是外科手术前的精液参数。在精液参数的最大的改进与更大的精索静脉曲张在人被发现。当有争吵，更高的睾丸激素，更年轻的年龄和更大的睾丸尺寸时，在一些，研究在精液参数postvaricocelectomy为改进预言。一张诺模图被开发了基于外科手术前的精液参数，精索静脉曲张等级和这个人(www.fertilitytreatmentresults.com)的年龄预言postvaricocelectomy精液参数。有限数据一致地与更高的基线DNA破碎率在人处于DNA破碎率表明最大的改进。关于繁殖结果，更高的基线精子密度一致地为自然怀孕或帮助繁殖技术(艺术)怀孕率预言。另外，精索静脉曲张修理确实似乎为艺术的更侵略的形式减少需要。在结论，我们现在能开始使用象预言跟随varicocelectomy的修理以后的精液质量和富饶潜力的基线精液质量，精索静脉曲张等级和耐心的年龄那样的特定的参数。

简介：Objective:Thepaperdiscussesrecentevidenceontheassessmentoflanguageoutcomesinchildrenwithhearinglossacquiringorallanguage.Methods:Researchemphasizesthatlanguagetestsmustbespecificenoughtocapturesubtledeficitsinvocabularyandgrammarlearningatdifferentdevelopmentalages.TheDiagnosticReceptiveandExpressiveAssessmentofMandarin(DREAM)wascarefullydesignedtobeacomprehensivestandardizedMandarinassessmentnormedinMainlandChina.Objective:Thepaperdiscussesrecentevidenceontheassessmentoflanguageoutcomesinchildrenwithhearinglossacquiringorallanguage.Methods:Researchemphasizesthatlanguagetestsmustbespecificenoughtocapturesubtledeficitsinvocabularyandgrammarlearningatdifferentdevelopmentalages.TheDiagnosticReceptiveandExpressiveAssessmentofMandarin(DREAM)wascarefullydesignedtobeacomprehensivestandardizedMandarinassessmentnormedinMainlandChina.Results:Thispapersummarizestheevidence-baseditemdesignprocessandvalidityandreliabilityresultsofDREAM.ApilotstudyreportedhereshowsthatDREAMprovideddetailedinformationabouthearingimpairedchildren’slanguageabilitiesandcanbeusedtoaidinterventionplanningtomaximizeprogress.Conclusion:DREAMrepresentsanexampleoftranslationalscience,transferringmethodsfromempiricalstudiesoflanguageacquisitioninresearchenvironmentsintoapplieddomainssuchasassessmentandintervention.ResearchonoutcomesinChinawilladvancesignificantlywiththeavailabilityofevidence-basedcomprehensivelanguageteststhatmeasureasufficientagerangeofskills,arenormedonMandarinspeakingchildreninmainlandChina,andaredesignedtocapturefeaturescentraltoMandarinlanguageacquisition.

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