Opening SCID newborn screening for novel exon genetic variants through whole-exome sequencing in China.

BACKGROUND: Severe combined immunodeficiency (SCID) is the most fatal form of inherited primary immunodeficiency disease. Known molecular defect mutations occur in most children with SCID. METHODS: Herein, we report Adenosine Deaminase-SCID (ADA-SCID) using whole-exome sequencing (WES), explore exome mutational landscape and significance for 17 SCID samples, and verify the mutated exon genes using the Gene Expression Omnibus (GEO) datasets. A total of 250 patients, who were hospitalized at the Neonatal Intensive Care Unit (NICU) of The Seventh Medical Center of the PLA General Hospital for 3 years (from 2017 to 2020), were screened for SCID. We collected mutated genes from the WES data of 17 SCID children. GSE609 and GSE99176 cohorts were used to identify the expressions of mutated exon genes and molecular features in SCID. Gene set variation analyses (GSVA) and correlation analyses were performed. RESULTS: The detection rate with approximately 6.8 % (17/250) of SCID is high in the NICU. A total of 16 genes were identified among 17 SCID samples, of which the Top 2 genes (MUC6 and RP11-683L23.1) might be crucial in the progression of SCID with 94 % mutation frequency. Furthermore, CNN2 and SCGB1C1 had significant co-mutations and may cooperate to affect SCID development. Importantly, the phylogenetic tree classification results of 17 SCID samples are more correlated to MUC6 with the most significant mutations. Expression profiles of seven mutated genes and five mutated genes were documented in GSE609 and GSE99176 cohorts based on microarray, respectively. Several immune-related pathways were significantly enriched, and Foxd4, differing from the other four mutated genes, was inversely correlated with the GSVA-enriched pathway. CONCLUSION: Due to its high detection rate (6.8%) and fatality rate (100%), the inclusion of SCID in newborn screening (NBS) is urgent for children in China. The WES successfully identified several common exonic variants (e.g., MUC6) and depicted the feature of mutations and evolution, which will help develop new diagnostic methods for SCID.

Expanding the clinical spectrum of anti-DPPX encephalitis: a multicenter retrospective study.

Objective: Anti-dipeptidyl-peptidase-like protein-6 (DPPX) encephalitis is a rare autoimmune encephalitis, and clinical and experimental information regarding this disease is limited. We conducted this study to comprehensively describe the clinical characteristics, ancillary test results, neuroimaging results, and treatment response in a group of Chinese patients with anti-DPPX encephalitis for better understanding this disease. Methods: We recruited 14 patients who tested positive for anti-DPPX antibodies in the serum and/or cerebrospinal fluid from 11 medical centers between March 2021 and June 2023. This retrospective study evaluated data on symptoms, autoantibody test, auxiliary examinations, treatments, and outcomes. Results: The average age at diagnosis was 45.93 ± 4.62 years (range: 11-72 years), and 9 of the 14 patients were males. The main symptoms included cognitive impairment (50.0%, 7/14), central nervous system hyperexcitability (42.9%, 6/14), gastrointestinal dysfunction (35.7%, 5/14), and psychiatric disorders (35.7%, 5/14). Notably, we discovered specific findings on 18F-fluorodeoxyglucose positron-emission tomography (PET)/magnetic resonance imaging in two patients. Co-existing autoantibodies were identified in two patients. Parainfection was identified in four patients. One patient had other autoimmune diseases, and one had tumor. Eleven patients received immunotherapy and most patients improved at discharge. Surprisingly, three male patients but no female patients relapsed during the 6 months of follow-up. Conclusion: The development and outcome of anti-DPPX encephalitis are variable. Male patients were predominant in our cohort. The most common symptoms were the classical triad of prodromal gastrointestinal dysfunction, cognitive and mental disorders, and central nervous system hyperexcitability. Infections, immune dysregulation, and tumors may be important etiologies. Long-term monitoring of disease development should be done in male patients. Overall, our results highlight novel clinical characteristics of anti-DPPX encephalitis.

Lower peripheral blood CD4+ lymphocyte ratio is associated with severe bronchopulmonary dysplasia.

OBJECTIVE: To elucidate the characteristics of lymphocyte subsets in bronchopulmonary dysplasia (BPD) diagnosis following Jensen's criterion to understand the spectrum of lymphocytes in different degrees of BPD. STUDY DESIGN: This single-center retrospective cohort study included 120 neonates admitted to the neonatal intensive care unit between 1 July 2014 and 30 June 2021, who had undergone peripheral blood lymphocyte subpopulation detection. RESULTS: Thirty-one neonates were included in the control group, whereas 33 infants with BPD were included in the case group. In addition, we selected 56 infants with a gestational age (GA) <37 weeks without BPD who were receiving oxygen therapy. Among the three groups, the B cell and NK cell frequencies were significantly higher and the frequencies of T cells and CD4+ cells were significantly lower in the BPD group. In newborns without BPD, the distribution of T lymphocyte subsets was similar at different GAs. Comparing different degrees of BPD, the patients in the grades 2-3 BPD group had significantly lower percentages of T lymphocytes and CD4+ T cells than those in the other groups. Remarkably, the frequencies of NK cells were significantly higher in patients with grades 2-3 BPD, and the Treg cells slightly increased with BPD severity, although the differences were not significant. CONCLUSION: Healthy neonates had similar ratios of lymphocyte subsets among different GAs; although as the GAs increased, the percentage of lymphocytes increased slightly. Severe BPD was associated with lower CD4+ T cells and higher NK cells. However, whether such changes were the cause or the consequence of BPD has not been determined.

Development of capability lists for neonatal critical care at three levels in China: a modified Delphi study.

BACKGROUND: The standardised management of neonatal critical care centres can help improve health outcomes of vulnerable newborns. Guidance is required to update evidence related to construction and management of neonatal critical care centres in China. OBJECTIVE: To establish expert consensus on the essential capability lists for neonatal critical care at three levels in China. DESIGN AND SETTING: According to China's administrative divisions, the Chinese guidelines stratifies neonatal critical care into three levels: county level (basic and special care), city level (intensive care) and province level (comprehensive care including neonatal surgery and more subspecialty interventions). A modified Delphi study was conducted. A group of 20 neonatologists from the Chinese Association of Neonatologists rated the importance of capability items on a 5-point Likert scale. RESULTS: At county level, the list consisted of 29 items related to basic and special care, and 3 items were unanimously rated very important by all experts: neonatal resuscitation, endotracheal intubation and continuous positive airway pressure ≥72 hours. At city level, group consensus defined 38 items as essential. Besides the essential items of county level, more items for intensive care were included in city level. At province level, 64 items reached consensus, including neonatal surgery and more advanced subspecialty interventions. The Kendall's W values showed good agreement among experts in both rounds, and an increase from round 1 to round 2. CONCLUSIONS: We developed the capability lists for neonatal critical care at three levels in China. Neonatal resuscitation should be provided by all levels. Interventions for preterm newborns are stratified according to gestational age and birth weight. Congenital abnormalities requiring surgical services need to be managed in high-level centres.

Classification of Glomerular Pathology Images in Children Using Convolutional Neural Networks with Improved SE-ResNet Module.

Classification of glomerular pathology based on histology sections is the key to diagnose the type and degree of kidney diseases. To address problems in the classification of glomerular lesions in children, a deep learning-based complete glomerular classification framework was designed to detect and classify glomerular pathology. A neural network integrating Resnet and Senet (RS-INet) was proposed and a glomerular classification algorithm implemented to achieve high-precision classification of glomerular pathology. SE-Resnet was applied with improvement by transforming the convolutional layer of the original Resnet residual block into a convolutional block with smaller parameters as well as reduced network parameters on the premise of ensuring network performance. Experimental results showed that our algorithm had the best performance in differentiating mesangial proliferative glomerulonephritis (MsPGN), crescent glomerulonephritis (CGN), and glomerulosclerosis (GS) from normal glomerulus (Normal) compared with other classification algorithms. The accuracy rates were 0.960, 0.940, 0.937, and 0.968, respectively. This suggests that the classification algorithm proposed in the present study is able to identify glomerular lesions with a higher precision, and distinguish similar glomerular pathologies from each other.

Impact of Bivalirudin on Patients with Acute Coronary Syndrome Undergoing Rotational Atherectomy in Real-Life Setting: A Retrospective Cohort Study.

BACKGROUND: No evidence exists on the impact of bivalirudin in patients with the acute coronary syndrome undergoing rotational atherectomy. This study aimed to evaluate the impact of bivalirudin on patients with acute coronary syndrome undergoing rotational atherectomy. METHODS: This was a retrospective cohort study conducted in our hospital between January 2017 and December 2019. The study included patients with acute coronary syndrome undergoing rotational atherectomy. Furthermore, 2 cohorts were included in this study (bivalirudin cohort and control cohort unfractionated heparin). The primary end-point was in-hospital net adverse clinical events. The secondary endpoint was all-cause mortality at 23 months. RESULTS: The study included 157 patients with 33 (21.0%) in the bivalirudin cohort and 124 (79.0%) in the control cohort. Net adverse clinical events during hospitalization in the bivalirudin cohort were higher than that in the control cohort [9 (27.3%) vs. 14 (11.3%), P = .021]. However, there was no significant difference in all-cause mortality at 23 months between the 2 cohorts [25 (20.2%) vs. 10 (30.3%), P =.214]. After adjusting for potential confounders, the usage of bivalirudin was not associated with net adverse clinical event (odds ratio = 0.90; 95% CI: 0.18-4.45; P =.890), and the hazard ratio for all-cause mortality at 23 months was 1.01 (95% CI: 0.33-3.15; P =.983). CONCLUSION: Bivalirudin appears to exhibit a similar impact as unfractionated heparin on patients with acute coronary syndrome undergoing rotational atherectomy in real-life setting.

Disease-specific data processing: An intelligent digital platform for diabetes based on model prediction and data analysis utilizing big data technology.

Background: Artificial intelligence technology has become a mainstream trend in the development of medical informatization. Because of the complex structure and a large amount of medical data generated in the current medical informatization process, big data technology to assist doctors in scientific research and analysis and obtain high-value information has become indispensable for medical and scientific research. Methods: This study aims to discuss the architecture of diabetes intelligent digital platform by analyzing existing data mining methods and platform building experience in the medical field, using a large data platform building technology utilizing the Hadoop system, model prediction, and data processing analysis methods based on the principles of statistics and machine learning. We propose three major building mechanisms, namely the medical data integration and governance mechanism (DCM), data sharing and privacy protection mechanism (DPM), and medical application and medical research mechanism (MCM), to break down the barriers between traditional medical research and digital medical research. Additionally, we built an efficient and convenient intelligent diabetes model prediction and data analysis platform for clinical research. Results: Research results from this platform are currently applied to medical research at Shanghai T Hospital. In terms of performance, the platform runs smoothly and is capable of handling massive amounts of medical data in real-time. In terms of functions, data acquisition, cleaning, and mining are all integrated into the system. Through a simple and intuitive interface operation, medical and scientific research data can be processed and analyzed conveniently and quickly. Conclusions: The platform can serve as an auxiliary tool for medical personnel and promote the development of medical informatization and scientific research. Also, the platform may provide the opportunity to deliver evidence-based digital therapeutics and support digital healthcare services for future medicine.

Mechanisms of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 Proteins in Serum Diagnosis of Neonatal Sepsis.

BACKGROUND: The mechanism of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 proteins in serum diagnosis of neonatal sepsis (NS) was explored. METHODS: Analysis of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 expression in serum from NS patients and their correlations were manifested. Evaluation of the ability of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 to identify NS was manifested. Analysis of the prognostic value of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 was in NS. RESULTS: Elevated PALLD, PRKCH, AKAP12, PDK4, and CHIT1 were found in serum from NS patients. Serum PALLD, PRKCH, AKAP12, PDK4, and CHIT1 have diagnostic value for NS. Moreover, PALLD could predict the overall survival of NS patients. CONCLUSIONS: This study clarifies elevated PALLD, PRKCH, AKAP12, PDK4, and CHIT1 in NS patients. Meanwhile, PALLD, PRKCH, AKAP12, PDK4, and CHIT1 are available to offer brand-new non-invasive biomarkers for NS's prognosis and diagnosis.

Effect of different revascularization times on intermediate-risk non-ST-elevation acute coronary syndrome.

Non-ST-elevation acute coronary syndrome (NSTE-ACS) is a specific type of acute coronary syndrome. We applied the Thrombolysis in Myocardial Infarction (TIMI) score for risk stratification of patient prognosis. There was uncertainty about the routine revascularization time in patients with intermediate-risk NSTE-ACS. A total of 2835 patients with intermediate-risk NSTE-ACS (TIMI score 3-4) included in the China Acute Myocardial Infarction Registry from November 2014 to January 2017 were analyzed according to the time window from symptom onset to revascularization: within 24 h, Group I (814/28.7%); within 24 to 48 h, Group II (526/18.6%); within 48 to 72 h, Group III (403/14.2%); and after 72 h, Group IV (1092/38.5%). Risk factors, management and in-hospital outcomes were analyzed in the four groups. The results of the chi-square test showed that there was a significant difference in the incidence of in-hospital major adverse cardiovascular events (MACEs) when revascularization was completed within 48 h than when it was completed after 48 h (P < 0.05). The results of revascularization within 48 h were similar, and the incidence of in-hospital MACEs was lower than when revascularization was completed after 48 h. The incidence of in-hospital MACEs among patients who underwent revascularization within 48 h is lower than that of patients who underwent revascularization after 48 h.

Effects of imbalance of lipid metabolism through NF-KB pathway on atherosclerosis and vascular aging in rats.

Cardiovascular diseases have become a mainstream disease by intensifying the country's population aging. The purpose of this article is to explore the specific effect and mechanism of lipid metabolism imbalance through the NF-KB pathway on atherosclerosis and vascular aging in rats. Twenty healthy adult rats were randomly divided into two groups, control in the observation group and the observation group. The rats in the observation group were fed a high-fat diet to imbalance the lipid metabolism of the rats. Immunohistochemistry and transmission electron microscope detectors were used to observe the NF-KB pathway in rats and study atherosclerosis-specific conditions of sclerosis and vascular aging. The results show that the imbalance of lipid metabolism through the NF-KB pathway can increase the rate of apoptosis in rat blood vessels by 24% and the proliferation rate by 18%. The number of vascular endothelial cell damage increased by 33%, which promoted atherosclerosis in rats and increased the rate of vascular aging in rats by 27%.

A novel fluorescent digitonin derivative for non-invasive skin cholesterol detection: potential application in atherosclerosis screening.

There is a great demand for the rapid and non-invasive atherosclerosis screening method. Cholesterol content in the epidermis of the skin is an early biomarker for atherosclerosis. Risk assessment of atherosclerosis can be achieved by measuring cholesterol in the epidermis. Here, we synthesised a new fluorescent digitonin derivative (FDD) for the non-invasive detection of skin cholesterol. The results of fluorescence spectroscopy studies indicated that the probe exhibited desirable selectivity for cholesterol. The proof-of-concept preclinical study confirmed that FDD can detect different concentrations of skin cholesterol; patients diagnosed with atherosclerotic cardiovascular disease and the at-risk atherosclerosis group exhibited higher skin cholesterol content than the normal group. The area under the ROC curve for distinguishing the normal/disease group was 0.9228 (95% confidence interval, 0.8938 to 0.9518), and the area under the ROC curve for distinguishing the normal/risk group was 0.9422 (95% confidence interval, 0.9178 to 0.9665). We anticipate that this non-invasive skin cholesterol test may be used as a risk assessment tool for atherosclerosis screening in a large population for further examination and intervention in high-risk populations.

Functional Analysis of Bronchopulmonary Dysplasia-Related Neuropeptides in Preterm Infants and miRNA-Based Diagnostic Model Construction.

Background: Bronchopulmonary dysplasia (BPD) has a high mortality rate. This study was aimed at identifying and analysing the risk factors associated with BPD using bioinformatic and mechanical analyses and establishing a predictive model to assess the risk of BPD in preterm infants. Methods: We identified differentially expressed RNAs via the intersection of miRNAs between datasets. Online analysis tools were used to predict genes targeted by differentially expressed miRNAs (DEmiRNAs) and to generate and visualise competing endogenous RNA (ceRNA) coexpression networks. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were subsequently performed on the DEmiRNAs. In addition, an intersection analysis was performed on mRNA and neuropeptide-related genes in the ceRNA network. DEmiRNAs associated with BPD and those involved in ceRNA networks were used to establish a diagnostic prediction model. The GSE108604 dataset was used as a validation set to verify the model. Results: A total of 26 DEmiRNAs were identified from the tracheal aspirates (TAs) of patients with BPD and healthy controls. In addition, a total of 1076 DEmRNAs were obtained from the GSE8586 dataset. Functional enrichment analysis of DEmRNAs revealed an abnormal reduction in mitochondrial-related activity and cellular responses to oxidative stress in patients with BPD. The neuropeptide-related genes OPRL1 and NPPA were found to be upregulated in BPD samples. Eventually, hsa-miR-1258, hsa-miR-298, hsa-miR-483-3p, and hsa-miR-769-5p were screened out and used to establish the prediction model. Calibration curves and detrended correspondence analysis (DCA) revealed that the model had good clinical applicability. Conclusions: The prediction model provided a simple method for individualised assessment, early diagnosis, and prevention of BPD risk in preterm infants.

Reduced myocardial septal function assessed by cardiac magnetic resonance feature tracking in patients with hypertrophic obstructive cardiomyopathy: associated with histological myocardial fibrosis and ventricular arrhythmias.

AIMS: Echocardiographic studies suggest that strain is related to myocardial fibrosis (MF) and ventricular arrhythmias (VA) in hypertrophic cardiomyopathy (HCM) patients. Cardiac magnetic resonance feature tracking (CMR-FT) also allows strain analysis, but little is known whether it provides incremental value to late gadolinium enhancement imaging (LGE). This study aimed to explore the relationship between CMR-FT-derived strain parameters and histopathology MF and VA and its incremental value to LGE in obstructive HCM (HOCM) patients undergoing septal myectomy. METHODS AND RESULTS: One hundred and twenty-three symptomatic HOCM patients underwent CMR examination, followed by septal myectomy. The abnormally increased histological MF was defined as higher than the mean + 2 standard deviation (SD) of nine control autopsy subjects who had no history of cardiovascular disease. Septal strain parameters and septal LGE were evaluated at the site of surgical myectomy. Among HOCM patients without LGE, septal circumferential (P = 0.003), longitudinal (P = 0.001), and radial (P = 0.02) strains were significantly impaired in patients with increased histological MF than those without. Histological MF was significantly associated with septal circumferential strain (r = 0.32, P < 0.001), septal longitudinal strain (r = 0.42, P < 0.001), and septal radial strain (r = -0.27, P = 0.003). On multivariate analysis, septal longitudinal strain was independently associated with histological MF [ß, 0.19 (0.05-0.34); P = 0.01], and VA [odds ratio, 1.10 (1.01-1.19); P = 0.02]. Moreover, septal longitudinal strain was incremental to septal %LGE in detecting increased MF (P = 0.001) and VA (P = 0.048). CONCLUSIONS: Septal longitudinal strain at CMR is independently related to histological MF and occurrence of VA in HOCM patients. Moreover, it provides incremental value over LGE in detecting increased MF and VA.

Treatment of neonates with respiratory distress syndrome by proportional assist ventilation plus synchronized intermittent mandatory ventilation: a comparison study.

BACKGROUND: The proportion assisted ventilation (PAV) can improve patient-ventilator interaction, reducing the incidence of end-expiratory asynchrony and increasing the time of synchrony. PAV could compensate for the leaks by elastic and resistive unloading and thus is ideal for neonates with uncuffed airways. The aim of this study was to compare the relevant clinical parameters of neonates with respiratory distress syndrome (RDS) who are supported by PAV plus synchronized intermittent mandatory ventilation (SIMV) and SIMV. METHODS: Forty-six neonates diagnosed as RDS who required mechanical ventilation were randomly divided into observer group (support by PAV+SIMV mode, N.=23) and control group (support by SIMV mode, N.=23). The X-ray grading situation, the number of asynchrony-delayed trigger, mean arterial blood pressure (MABP), spontaneous respiratory rate (RR), heart rate (HR), blood gas analysis values and circulation and respiratory parameters at each timepoint after 30 minutes, 12, 24, 48 and 72 hours of mechanical ventilation were observed. RESULTS: The forty-four neonates in two groups have been cured, the other 2 neonates (one in each group) gave up treatment and automatically discharged. There were no statistically significant differences in male, gestational age, body weight, duration of mechanical ventilation, oxygen dependence and hospital stay between the two groups (all P>0.05). There were no statistically significant differences in MABP, HR and ratio of arterial-to-alveolar partial pressure of oxygen (a/APO2) at each time point after mechanical ventilation between the two groups(all P>0.05). The number of asynchrony-delayed trigger in observer group was lower than that in control group, the difference was statistically significant (P<0.05). The number of spontaneous RR in observer group was higher than that in control group. The difference was statistically significant (P<0.05). CONCLUSIONS: The PAV plus SIMV shows a good clinical effect in treatment of neonates with RDS. It could be better to use neonatal spontaneous breathing and might cause less damage to the lung than SIMV mode.

[A High-definition Recording Method of Electrocardiogram].

In order to improve the clarity of ECG waveforms and the anti-interference ability of ECG acquisition under abnormal conditions, this study proposes a high-definition ECG recording method based on superimposed averaging algorithm. The results show that the proposed method can more clearly reflect the details of the ECG. Meanwhile, it has a significant inhibitory effect on EMG interference. As a result, the proposed method has a positive significance for improving the anti-interference ability of ECG equipment.

UCHL1 inhibition attenuates cardiac fibrosis via modulation of nuclear factor-κB signaling in fibroblasts.

The ubiquitin-proteasome system (UPS) plays an essential role in cellular homeostasis and myocardial function. Ubiquitin carboxy-terminal hydrolase 1 (UCHL1) is involved in cardiac remodeling, but its underlying mechanisms are largely unknown. Here, we observed that the UCHL1 was significantly up-regulated in angiotensin II-infused heart and primary cardiac fibroblast (CF). Systemic administration of the UCHL1 inhibitor LDN57444 significantly ameliorated cardiac fibrosis and improved cardiac function induced by angiotensin II. Also, LDN57444 inhibited CF cell proliferation as well as attenuated collagen I, and CTGF gene expression in the presence of Ang II. Mechanistically, UCHL1 promotes angiotensin II-induced fibrotic responses by way of activating nuclear factor kappa B (NF-κB) signaling. Moreover, suppression of the NF-κB pathway interfered with UCHL1 overexpression-mediated fibrotic responses. Besides, the chromatin immunoprecipitation assay demonstrated that NF-κB can bind to the UCHL1 promoter and trigger its transcription in cardiac fibroblasts. These findings suggest that UCHL1 positively regulates cardiac fibrosis by modulating NF-κB signaling pathway and identify UCHL1 could be a new treatment strategy for cardiac fibrosis.

[Clinical features of very preterm small-for-gestational-age infants born due to severe preeclampsia].

OBJECTIVE: To study the clinical features of very preterm small-for-gestational-age infants born by cesarean section due to severe preeclampsia. METHODS: Forty-two small-for-gestational-age infants who were admitted from August 2017 to July 2018 and were born due to severe preeclampsia were enrolled as the observation group. Forty very preterm infants who were born to healthy mothers since uterine contractions could not be suppressed were enrolled as the control group. Perinatal features, clinical manifestations of infection, complications, and clinical outcomes were analyzed for the two groups. RESULTS: Within 6 hours and 2-3 days after birth, the observation group had significantly lower white blood cell count (WBC), absolute neutrophil count (ANC), and platelet count (PLT) than the control group (P < 0.05). At 5-7 days after birth, there was no significant difference in WBC between the two groups (P > 0.05), while the observation group still had significantly lower ANC and PLT than the control group (P < 0.05). The observation group had a significantly higher C-reactive protein (CRP) level than the control group at 2-3 days and 5-7 days after birth (P < 0.05). The observation group had a significantly higher proportion of infants with severe infections than the control group (P < 0.05). The observation group had a significantly higher hemoglobin level than the control group within 6 hours after birth (P < 0.05). The observation group had a significantly higher incidence rate of bronchopulmonary dysplasia than the control group (P < 0.05). There was no significant difference between the two groups in the rate of pulmonary hemorrhage, intracranial hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, and the rate of use of invasive ventilation, and clinical outcomes (P > 0.05). CONCLUSIONS: Very preterm small-for-gestational-age infants born due to severe preeclampsia have a high incidence rate of infection and severe conditions. Early manifestations include reductions in the infection indicators WBC, ANC, and PLT, and CRP does not increase significantly in the early stage and gradually increases at 2-3 days after birth. Most of these infants require invasive ventilation after birth, with bronchopulmonary dysplasia as the main complication. Clinical changes should be closely observed and inflammatory indicators should be monitored for early identification of infection, timely diagnosis, and timely adjustment of antibiotic treatment, so as to improve the outcome.

Predictive value of ACEF score for clinical prognosis of elderly patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention.

BACKGROUND: To investigate the predictive value of the age, creatinine, and ejection fraction (ACEF) score for cardiac death in patients aged ≥75 years diagnosed with acute ST-segment elevation myocardial infarction (STEMI) at 1 month and 1 year after emergency percutaneous coronary intervention (PCI). METHODS: A total of 360 patients with STEMI undergoing emergency PCI in the Department of Cardiology of Anhui Provincial Hospital from January 2013 to April 2018 were consecutively recruited. The primary endpoint event was cardiac death at postoperative 1 month and 1 year. The ROC curve was utilized to evaluate ACEF scoring system and predict cardiac death rate. RESULTS: According to ACEF score upon admission, 360 patients were divided into low-to-intermediate risk group (n=80) with ACEF score of 0.99-1.27 (1.18±0.07) and high-risk group (n=280) with ACEF score of 1.28-4.14 (1.83±0.51). The age, left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), heart rate and the proportion of complete revascularization in the high-risk group were significantly higher than those in low-to-intermediate risk group (all P<0.05). The area under ROC curve for ACEF scoring system to predict cardiac death at 1 month and 1 year following PCI was 0.809 and 0.763, respectively. CONCLUSIONS: ACEF value upon admission can predict the cardiac death rate at 1 month and 1 year after emergency PCI in STEMI patients aged ≥75 years old.

Antenatal corticosteroids administration on mortality and morbidity in premature twins born at 25∼34 gestational weeks: A retrospective multicenter study.

OBJECTIVE: To evaluate the effects of antenatal corticosteroids (ACS) administration on mortality and major neonatal complications in early life of preterm twins. STUDY DESIGN: This study retrospectively enrolled 1 662 twins delivered at 25∼34+6gestational weeks in China from January 2013 to December 2014. They were divided into ACS group and no-ACS group according to weather their mothers received ACS or not. Moreover, they were subgrouped as 25∼27+6 and 28∼34+6gestational week groups. Multivariable logistic regression was used to analyze the effects of ACS on the incidence of mortality and major morbidities. RESULTS: A total of 910 neonates (54.8 %) received one or more doses of ACS, and 752 neonates (45.2 %) did not receive any ACS. No significant difference in infant mortality was observed between the ACS and no-ACS groups (P = 0.321). The ACS group had decreased incidence of respiratory distress syndrome (RDS) and mild RDS compared with the no-ACS group (both P < 0.05). There were no significant differences in the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, sepsis and severe RDS between the two groups (all P > 0.05). The subgroup analysis showed that the incidence of RDS was lower in the ACS group than in the no-ACS group (P = 0.036) at 28∼34+6weeks. However, the incidence of mild ROP was higher in the ACS group than that in the no-ACS group (P = 0.047) at 25∼27+6 weeks. Multivariable logistic regression analysis demonstrated a decreasing risk of RDS (aOR = 0.661, 95 %CI:0.506-0.863, P = 0.002) after adjusting the gestational week, birth weight, small for gestational age, delivery mode, 5 min Apgar score, and maternal perinatal complications. CONCLUSION: In twin preterm infants, ACS administration is associated with a reduced risk of RDS. However, our data suggest that it may not have a beneficial effect on mortality and other short-term morbidities.

Efficacy and safety of bivalirudin application during primary percutaneous coronary intervention in older patients with acute ST-segment elevation myocardial infarction.

OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) is the most serious type of acute coronary syndrome. This study aimed to investigate the efficacy and safety of bivalirudin application during primary percutaneous coronary intervention (PPCI) in older patients with acute STEMI. METHODS: A total of 672 older patients with STEMI (>75 years) who underwent PPCI were studied. The primary endpoints were 30-day net adverse clinical events (NACEs) post-emergency percutaneous coronary intervention, including major adverse cardiac and cerebrovascular events (MACCEs) and Bleeding Academic Research Consortium grades 2 to 5 (BARC 2-5) bleeding events. RESULTS: The incidence of NACEs and BARC 2-5 bleeding events in the bivalirudin group was significantly lower than that in the unfractionated heparin group. Multivariate Cox regression analysis showed that bivalirudin significantly reduced 30-day NACEs (odds ratio: 0.700, 95% confidence interval: 0.492-0.995) and BARC 2-5 bleeding events (odds ratio: 0.561, 95% confidence interval: 0.343-0.918). At 1-year follow-up, these results were similar. CONCLUSIONS: Bivalirudin can be safely and effectively used during PPCI in older patients with STEMI. Bivalirudin reduces the risks of NACEs and bleeding within 30 days after PPCI, without increasing the risks of MACCEs and stent thrombosis compared with heparin.