[An investigation of severe neonatal hyperbilirubinemia in 13 hospitals of Jiangsu Province, China].

OBJECTIVE: To investigate the incidence of severe neonatal hyperbilirubinemia and the management on the treatment and follow-up of this disease in Jiangsu Province, China. METHODS: The neonates with severe hyperbilirubinemia who were admitted to 13 hospitals in Jiangsu Province from January to December, 2018, were enrolled as subjects. A retrospective analysis was performed on their mediacal data and follow-up data. RESULTS: In 2018, 740 neonates with severe hyperbilirubinemia were reported from the 13 hospitals in Jiangsu Province, accounting for 2.70% (740/27 386) of the total number of neonates admitted to the department of neonatology. Among these neonates, 620 (83.8%) had severe hyperbilirubinemia, 106 (14.3%) had extremely severe hyperbilirubinemia, and 14 (1.9%) had hazardous hyperbilirubinemia. Four neonates (0.5%) were diagnosed with acute bilirubin encephalopathy. A total of 484 neonates (65.4%) were readmitted due to severe hyperbilirubinemia after discharge from the delivery institution, with a median age of 7 days, among whom 214 (44.2%) were followed up for jaundice at the outpatient service before readmission, with a median age of 6 days at the first time of outpatient examination. During hospitalization, 211 neonates (28.5%) underwent cranial MRI examinations, among whom 85 (40.3%) had high T1WI signal in the bilateral basal ganglia and the globus pallidus; 238 neonates (32.2%) underwent brainstem auditory evoked potential examinations, among whom 14 (5.9%) passed only at one side and 7 (2.9%) failed at both sides. The 17 neonates with acute bilirubin encephalopathy or hazardous hyperbilirubinemia were followed up. Except one neonate was lost to follow-up, and there were no abnormal neurological symptoms in the other neonates. CONCLUSIONS: Neonates with severe hyperbilirubinemia account for a relatively high proportion of the total number of neonates in the department of neonatology. Jaundice monitoring and management after discharge from delivery institutions need to be strengthened. For neonates with severe hyperbilirubinemia, relevant examinations should be carried out more comprehensively during hospitalization and these neonates should be followed up comprehensively and systematically after discharge.

[Effects of different feeding patterns on the growth and development of infants with very/extremely low birth weight].

OBJECTIVE: To investigate the growth and development of very low birth weight (VLBW)/extremely low birth weight (ELBW) preterm infants within the corrected age of 6 months and the effect of different feeding patterns on growth and development. METHODS: A total of 109 VLBW/ELBW preterm infants who were discharged from January 2016 to April 2017 and who had completed regular follow-up were enrolled, and their growth and development within the corrected age of 6 months were monitored. The Z-score method was used to evaluate physical indices and analyze the effect of different feeding patterns (breastfeeding group: breast milk + human milk fortifier; mixed feeding group: breast milk + preterm formula milk; artificial feeding: preterm formula milk) on growth and development. RESULTS: The peaks of weight-for-age Z-score, height-for-age Z-score, weight-for-height Z-score, and BMI-for-age Z-score occurred within the corrected age of 3 months, and the peak of head circumference-for-age Z-score occurred at the corrected age of 5 months. Growth deviation of the infants often occurred within the corrected age of 1-3 months. At the corrected age of 3 months, the breastfeeding group had significantly better body weight, height and head circumference growth than the mixed feeding group and/or the artificial feeding group (P<0.05). At the corrected age of 6 months, the breastfeeding group had significantly better head circumference and body length growth than the mixed feeding group and/or the artificial feeding group (P<0.05). CONCLUSIONS: Growth deviation of VLBW/ELBW preterm infants often occurs within the corrected age of 1-3 months, suggesting that early individualized follow-up and nutritional guidance should be strengthened to reduce growth deviation. Maternal breastfeeding with the addition of human milk fortifier is the best feeding pattern for VLBW/ELBW preterm infants.

[A single-center study on the incidence and mortality of preterm infants from 2006 to 2016].

OBJECTIVE: To investigate the incidence and mortality rates of preterm infants and the main causes of death. METHODS: The basic information of preterm infants was collected from their medical records and admission/discharge records to analyze the incidence and mortality rates of preterm infants and the causes of their death. RESULTS: There were 76 812 neonates born in the Xuzhou Maternal and Child Health Hospital from January 2006 to December 2016, among whom 5 585 (7.27%) were preterm infants. The incidence rate of preterm infants tended to increase over these years (P<0.001). The overall mortality rate was 5.01% (280/5 585), and the mortality rate tended to decrease over these years (P<0.001). The mortality rate increased with the reductions in birth weight and gestational age (P<0.001). The top four causes of death in preterm infants were respiratory distress syndrome (44.3%), severe asphyxia (12.9%), neonatal malformation (4.3%), and pulmonary hemorrhage (2.9%) respectively. With the increase in birth weight, there were significant reductions in the constituent ratios of death due to respiratory distress syndrome and severe asphyxia (P<0.001). CONCLUSIONS: The incidence rate of preterm infants tended to increase and their mortality rate tended to decrease from 2006 to 2016. The mortality rate of preterm infants is associated with gestational age and birth weight. Respiratory distress syndrome and severe asphyxia are the main causes of death in preterm infants.

In vivo emergence of a novel mutant L159F/L320F in the NS5B polymerase confers low-level resistance to the HCV polymerase inhibitors mericitabine and sofosbuvir.

BACKGROUND: Resistance to mericitabine (prodrug of HCV NS5B polymerase inhibitor PSI-6130) is rare and conferred by the NS5B S282T mutation. METHODS: Serum HCV RNA from patients who experienced viral breakthrough, partial response, or nonresponse in 2 clinical trials in which patients received mericitabine plus peginterferon alfa-2a (40KD)/ribavirin were analyzed by population and clonal sequence analysis as well as phenotypic assay for assessment of in vivo mericitabine resistance. RESULTS: Among 405 patients treated with mericitabine plus peginterferon alfa-2a/ribavirin in PROPEL and JUMP-C, virologic breakthrough or nonresponse were not observed; 12 patients experienced a partial response. The NS5B S282T resistance mutation was not observed in any patient. A number of treatment-associated NS5B changes were observed and characterized. A novel double mutant (L159F/L320F) with impaired replication capacity was detected in one HCV genotype 1b-infected patient. Introduction of double mutant L159F/L320F into genotype 1a (H77) and 1b (Con-1) replicons, respectively, increased the EC50 for mericitabine by 3.1- and 5.5-fold and the EC90 by 3.1- and 8.9-fold. The double mutant also decreased susceptibility to sofosbuvir (GS-7977) and GS-938 but not setrobuvir, relative to wild-type. CONCLUSIONS: A novel and replication-deficient double mutation (L159F/L320F) confers low-level resistance to mericitabine and cross-resistance to both sofosbuvir and GS-938. CLINICAL TRIALS REGISTRATION: NCT00869661, NCT01057667.

RG7128 alone or in combination with pegylated interferon-α2a and ribavirin prevents hepatitis C virus (HCV) Replication and selection of resistant variants in HCV-infected patients.

INTRODUCTION: RG7128 (prodrug of PSI-6130) shows potent antiviral efficacy in patients infected with hepatitis C virus (HCV) genotypes 1, 2, or 3, with mean viral load decreases of 2.7 and 5 log(10) IU/mL, respectively, associated with 1500-mg doses twice daily after monotherapy for 2 weeks and with 1000-mg and 1500-mg doses twice daily after treatment in combination with the standard of care (SOC) for 4 weeks. RESULTS: From 32 patients treated with RG7128 monotherapy for 2 weeks, marginal viral load rebound was observed in 3 HCV genotype 1-infected patients, whereas partial response was observed in 2 genotype 1-infected patients. From 85 patients receiving RG7128 in combination with SOC, 1 HCV genotype 1-infected patient experienced a viral rebound, and 2 genotype 3-infected patients experienced a transient rebound. Five genotype 1-infected patients had an HCV load of >1000 IU/mL at the end of 4-week treatment. No viral resistance was observed, per NS5B sequencing and phenotypic studies. PSI-6130 resistance substitution S282T needs to be present at levels of ≥90% within a patient's quasispecies to confer low-level resistance. No evidence of S282T was found by population or clonal sequence analyses. CONCLUSIONS: The requirement for a predominant S282T mutant quasispecies, its low replication capacity, and the low-level resistance it confers probably contribute to the lack of RG7128 resistance observed in HCV-infected patients.

[Diagnostic capacity of skin prick test in egg and cow's milk allergic infants].

OBJECTIVE: Mean diameter is the most common used parameter for wheal response assessment after skin prick test. This study aimed to investigate the diagnostic capacity of mean diameter according to the outcome of oral food challenge, and to determine the cut-off points that could render food challenges unnecessary. METHOD: Data of 173 children referred to the Division of Primary Child Health Care for the evaluation of suspected food allergy were prospectively studied. All children underwent skin prick test and open food challenge to the relevant food(s) in clinic. The mean wheal diameter of skin prick test was measured, and open food challenge was performed to confirm food allergy. The SPSS software package version 13.0 for windows (SPSS, Chicago, IL, USA) was used for all statistical analysis. Open food challenge was taken as the gold standard for diagnosis. Diagnostic capacity of skin prick test, including the sensitivity, specificity, positive predictive value, negative predictive value, was calculated by cross-table. In addition, receiver operating characteristic curve (ROC) was plotted and area under the curve (AUC) was calculated to quantify the accuracy of the parameter. RESULT: For the 173 children, 271 open food challenges were performed with egg white, egg yolk and cow's milk, In which 123 were positive, 99 children were diagnosed as food allergy. Cutaneous symptoms (87.0%) were most common, followed by gastrointestinal symptoms (9.8%). The AUC of mean diameter was 0.794 for egg white, 0.804 for egg yolk and 0.904 for cow's milk. The sensitivity of skin prick test with a cut-off value of ≥ 3 mm was ranged from 71% to 87%, while the specificity was between 31% and 57%. The authors also defined food specific skin prick test mean diameters that were 100% diagnostic for allergy to egg white (≥ 8.5 mm), egg yolk (≥ 5.5 mm), cow's milk (≥ 5.5 mm). CONCLUSION: Predictive decision points for a positive outcome of food challenges can be calculated for egg and cow's milk using mean diameter. It may help to simplify the diagnostic procedure of food allergy.

[Evaluation of therapeutic effects of three hypoallergenic formulae in infants with cow's milk protein allergy].

OBJECTIVE: To compare the growth and symptom remission of infants with cow's milk protein allergy, who were fed with an amino acid formula, an extensively hydrolyzed formula or soy formula. METHOD: Infants who were diagnosed as cow's milk protein allergy and can not be breastfed were enrolled in the intervention group, and were assigned to three special formulae (amino acid formula, extensively hydrolyzed formula or soy formula ) according to the will of parents from March 2009 to March 2010 (n = 74). A non-randomized control group was made up of age-matched healthy children (n = 21). Anthropometric measurements and symptoms were evaluated after 30, 60, 90, and 180 days. The differences of physical growth and the therapeutic effects among each group were calculated by SPSS 13.0 package. RESULT: After 180 days follow-up, the weight for age Z score and length for weight Z score were -0.43 +/- 0.88 and -0.31 +/- 0.78 in patients fed with soy formula substitute, which were significantly lower than those of patients fed with amino acid formula (0.11 +/- 0.77, 0.20 +/- 0.69) , extensively hydrolyzed formula (0.10 +/- 0.62, 0.18 +/- 0.70) and control group (0.22 +/- 0.54, 0.22 +/- 0.64) (P<0.05). However, there were no significant differences in physical growth among patients fed with amino acid formula, extensively hydrolyzed formula and control group (P>0.05). Moreover, no significant difference was found in length for age and head circumference for age among four groups (P>0.05). All hypoallergenic formulae were much helpful in remission of the symptoms of eczema (P<0.05). However, amino acid formula and extensively hydrolyzed formula were more effective and rapid in relieving symptoms than soy formula (1 mo vs 2 mo) (P = 0.003). CONCLUSION: Both amino acid formula and extensively hydrolyzed formula can maintain the normal growth of infants with cow's milk protein allergy. While, the growth of patients fed with soy formula was significantly slower than that of the other three groups. All hypoallergenic formulae can be effective in relieving allergy symptoms, and amino acid formula or extensively hydrolyzed formula seems to be superior to soy formula.

Electrochemical removal of chromium from aqueous solutions using electrodes of stainless steel nets coated with single wall carbon nanotubes.

An electrochemical technique was adopted to investigate the removal of Cr(VI) species and total chromium (TCr) from aqueous solution at a laboratory scale. The electrodes of stainless steel nets (SSNE) coated with single wall carbon nanotubes (SWCNTs@SSNE) were used as both anode and cathode. Three parameters, including solution pH, voltage and electrolyte concentration, were studied to explore the optimal condition of chromium removal. The optimal parameters were found to be pH 4, voltage 2.5 V and electrolyte concentration 10 mg/L. Under these conditions, the Cr(VI) and TCr removal had a high correlation with the amount of SWCNTs coated on the electrodes, with coefficients of the regression equations 0.953 and 0.928, respectively. The mechanism of Cr(VI) removal was also investigated. X-ray photoelectron spectroscopy (XPS) study and scanning electron microscope (SEM) picture showed that the process of chromium removal involved the reduction of Cr(VI) to Cr(III) on the cathode, and then the adsorption of Cr(III) by SWCNTs on the cathode. The study results indicated that the proposed method provided an interesting means to remove chromium species from aqueous solution, especially Cr(VI) in acidic condition.