A case of survived extremely preterm infant with severe bronchopulmonary dysplasia after comprehensive therapy / 中华围产医学杂志

This article reported the comprehensive management of an extremely preterm infant with severe bronchopulmonary dysplasia. The patient born at 26 +6 gestational weeks was transferred to Children's Hospital of Fudan University due to invasive mechanical ventilation dependence at 61 d after birth and was diagnosed with severe bronchopulmonary dysplasia. A comprehensive treatment plan was adopted, including appropriate fluid restriction, improving nutrition, glucocorticoid administration, using antibiotics against Ureaplasma urealyticum infection to reduce pulmonary parenchymal lesions and alleviating pulmonary hypertension. The preterm infant was successfully extubated to non-invasive ventilation and subsequently weaned to a high-flow nasal cannula. Then, the patient was discharged at 372 d after birth (correct gestational age nine months and six days). At the 3-month follow-up after discharge, the patient remained on high-flow oxygen, but with lower flow and concentration of oxygen. Moreover, the growth, development and lung images were significantly improved. Follow-up to correct gestational age one year and 11 months, the child was not on oxygen any more, but on rehabilitation due to language and motor development retardation.

Trajectory and impact factors of cycle threshold values of virus load in respiratory tract in children infected with severe acute respiratory syndrome coronavirus 2 Omicron variants / 中华传染病杂志

Objective:To investigate the clinical characteristics of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants, and the impact factors of duration of cycle threshold (Ct) values turning to ≥35 detected by nucleotide test.Methods:Children aged 0 to 14 years with clinical symptoms of Omicron variants infection who admitted to designated hospital in Shanghai City (Renji Hospital, South Branch, Shanghai Jiao Tong University School of Medicine) from April 7 to June 2, 2022 were enrolled. The daily nasopharyngeal swab specimens were used for SARS-CoV-2 nucleic acid detecting by polymerase chain reaction and the results were expressed as Ct values. The T Ct≥ x was defined as from the symptom onset or first positive nucleic acid test results (the earlier data) to Ct≥ x of the open reading frame 1ab ( ORF1 ab) gene, which was the time duration from the initial to a specific Ct value.Clinical data were collected, including age, sex, vaccination and comorbidities.Cox model was performed to analyzed the impact factors of T Ct≥35. Results:A total of 871 pediatric cases with a median age of two years (ranging from one month to 14 years old) were included. Among them, 474 cases (54.4%) were male, and 89 cases (10.2%) had underlying diseases including congenital heart disease, solid tumors and epilepsy. There were 572(65.7%) mild cases, 298(34.2%) common cases, one (0.1%) severe case and no critical cases or deaths. The T Ct≥35 was 12(10, 14) days. Cox model indicated that compared to children aged one to 12 months, children aged 37 to 84 months and 85 to 168 months had shorter T Ct≥35 (hazard ratio ( HR)=1.55 and 1.84, respectively, both P<0.001). After adjusted with age, comparing to unvaccinated patients, patients with one or two shots vaccine had shorter T Ct≥35 (adjected hazard ratio (a HR)=1.49, P=0.011), and common patients had longer T Ct≥35 than mild patients (a HR=0.78, P=0.002), and patients with comorbidities had longer T Ct≥35than patients without comorbidities (a HR=0.38, P<0.001).The duration of T Ct≥28, T Ct≥30, T Ct≥33 and T Ct≥35 in children without underlying diseases were 7(6, 9) d, 9(7, 10) d, 10(8, 11) d and 12(10, 14) d, respectively. Conclusions:Age, vaccination, disease severity and underlying diseases could affect the duration of SARS-CoV-2 nucleotide turning to negative (Ct value≥35) in children infected with Omicron variants.

Evidence and experience in management of neonatal COVID-19 / 中华围产医学杂志

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has mutated multiple times since the first report in December 2019 and is still spreading globally. A variant of SARS-CoV-2, Omicron, was prevalent in Shanghai from March to May 2022. Based on published data and the experience in the management of neonatal COVID-19 cases and infants of mothers with COVID-19 during the pandemic in Shanghai, it is suggested that neonates are infected with SARS-CoV-2 mainly through postnatal horizontal transmission, but rarely through vertical transmission. The risk of SARS-CoV-2 infection in infants born to mothers with COVID-19 is low if quarantine measures are appropriately implemented. Even if they are infected, the risk of severe neonatal COVID-19 is low, but long-term neurological prognosis needs to be followed closely. Human milk feeding without contact is advocated for infants of infected mothers. During the COVID-19 pandemic, attention should also be paid to indirect effect on neonatal health due to possible inadequate medical resources.

Advances in drug prophylaxis against bronchopulmonary dysplasia / 中华围产医学杂志

Bronchopulmonary dysplasia (BPD) is a common respiratory complication after preterm birth that severely affects the prognosis and quality of life in preterm infants. In recent years, significant progress has been made in neonatal care, but the incidence of BPD remains high. After long-term exploration and application, some medications such as exogenous pulmonary surfactants, glucocorticoids and caffeine have been widely used for the prevention and treatment of BPD. However, some medications including diuretics, inhaled nitric oxide and bronchodilators have not been proved to be effective and safe. This review summarizes the present drugs for the prevention of BPD in publications.

Study on nutritional risk and nutritional support in patients with liver cancer during perioperative period / 中国医师进修杂志

Objective:To study the nutritional risk and nutritional support in patients with liver cancer during perioperative period.Methods:In Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical, the clinical data of 507 liver cancer patients who underwent surgery College from January 2019 to January 2020 were retrospectively analyzed. The perioperative nutrition was assessed by nutritional risk screening 2002 (NRS 2002), ≥3 scores was diagnosed nutritional risk, and the nutritional support was counted.Results:Among 507 patients, 82 cases (16.2%) had nutritional risk. There was no statistical difference in rate of nutritional risk between male and female: 15.3% (58/379) vs. 18.8% (24/128), χ2 = 0.838, P>0.05. There was no statistical difference in rate of nutritional risk between primary liver cancer patients and secondary liver cancer patients: 18.0% (63/350) vs. 12.1% (19/157), χ2 = 2.781, P>0.05. The rate of nutritional risk in ≥ 60 years old patients was significantly higher than that in <60 years old patients: 25.9% (62/239) vs. 7.5% (20/268), and there was statistical difference ( χ2 = 31.819, P<0.01). The age, incidence of dystrophy and rate of nutritional support before surgery in patients with nutritional risk were significantly higher than those in patients without nutritional risk: (65.3 ± 12.7) years old vs. (55.9 ± 8.9) years old, 13.4% (11/82) vs. 0 and 24.4% (20/82) vs. 2.6% (11/425), and there were statistical differences ( P<0.01); there were no statistical differences in sex composition, tumor origin, rate of nutritional support after surgery and albumin between patients with nutritional risk and patients without nutritional risk ( P>0.05). Among 31 nutritional support patients before surgery, parenteral nutrition (PN) was in 1 case, enteral nutrition (EN) was in 30 cases; among 453 nutritional support patients after surgery, PN was in 297 cases, EN was in 27 cases, and PN + EN was in 129 cases. Conclusions:The incidence of nutritional risk in patients with liver cancer during perioperative period is high, and especially elderly patients should pay attention to nutritional support. NRS 2002 is a powerful tool and should be recommended to use at patients with liver cancer, and provide the evidence of nutritional therapy.

Application value of machine learning algorithms and COX nomogram in the survival prediction of hepatocellular carcinoma after resection / 中华消化外科杂志

Objective:To investigate the application value of machine learning algorithms and COX nomogram in the survival prediction of hepatocellular carcinoma (HCC) after resection.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 375 patients with HCC who underwent radical resection in the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College from January 2012 to January 2017 were collected. There were 304 males and 71 females, aged from 21 to 79 years, with a median age of 57 years. According to the random numbers showed in the computer, 375 patients were divided into training dataset consisting of 300 patients and validation dataset consisting of 75 patients, with a ratio of 8∶2. Machine learning algorithms including logistic regression (LR), supporting vector machine (SVM), decision tree (DT), random forest (RF), and artificial neural network (ANN) were used to construct survival prediction models for HCC after resection, so as to identify the optimal machine learning algorithm prediction model. A COX nomogram prediction model for predicting postoperative survival in patients with HCC was also constructed. Comparison of performance for predicting postoperative survival of HCC patients was conducted between the optimal machine learning algorithm prediction model and the COX nomogram prediction model. Observation indicators: (1) analysis of clinicopathological data of patients in the training dataset and validation dataset; (2) follow-up and survival of patients in the training dataset and validation dataset; (3) construction and evaluation of machine learning algorithm prediction models; (4) construction and evaluation of COX nomogram prediction model; (5) evaluation of prediction performance between RF machine learning algorithm prediction model and COX nomogram prediction model. Follow-up was performed using outpatient examination or telephone interview to detect survival of patients up to December 2019 or death. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was analyzed by the paired t test. Measurement data with skewed distribution were expressed as M ( P25, P75) or M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were represented as absolute numbers. Comparison between groups was performed using the chi-square test when Tmin ≥5 and N ≥40, using the calibration chi-square test when 1≤ Tmin ≤5 and N ≥40, and using Fisher exact probability when Tmin <1 or N <40. The Kaplan-Meier method was used to calculate survival rate and draw survival curve. The COX proportional hazard model was used for univariate analysis, and variables with P<0.2 were included for the Lasso regression analysis. According to the lambda value, variables affecting prognosis were screened for COX proportional hazard model to perform multivariate analysis. Results:(1) Analysis of clinicopathological data of patients in the training dataset and validation dataset: cases without microvascular invasion or with microvascular invasion, cases without liver cirrhosis or with liver cirrhosis of the training dataset were 292, 8, 105, 195, respectively, versus 69, 6, 37, 38 of the validation dataset, showing significant differences between the two groups ( χ2=4.749, 5.239, P<0.05). (2) Follow-up and survival of patients in the training dataset and validation dataset: all the 375 patients received follow-up. The 300 patients in the training dataset were followed up for 1.1-85.5 months, with a median follow-up time of 50.3 months. Seventy-five patients in the validation dataset were followed up for 1.0-85.7 months, with a median follow-up time of 46.7 months. The postoperative 1-, 3-year overall survival rates of the 375 patients were 91.7%, 79.5%. The postoperative 1-, 3-year overall survival rates of the training dataset were 92.0%, 79.7%, versus 90.7%, 81.9% of the validation dataset, showing no significant difference in postoperative survival between the two groups ( χ2=0.113, P>0.05). (3) Construction and evaluation of machine learning algorithm prediction models. ① Selection of the optimal machine learning algorithm prediction model: according to information divergence of variables for prediction of 3 years postoperative survival of HCC, five machine learning algorithms were used to comprehensively rank the variables of clinicopathological factors of HCC, including LR, SVM, DT, RF, and ANN. The main predictive factors were screened out, as hepatitis B e antigen (HBeAg), surgical procedure, maximum tumor diameter, perioperative blood transfusion, liver capsule invasion, and liver segment Ⅳ invasion. The rank sequence 3, 6, 9, 12, 15, 18, 21, 24, 27, 29 variables of predictive factors were introduced into 5 machine learning algorithms in turn. The results showed that the area under curve (AUC) of the receiver operating charateristic curve of LR, SVM, DT, and RF machine learning algorithm prediction models tended to be stable when 9 variables are introduced. When more than 12 variables were introduced, the AUC of ANN machine learning algorithm prediction model fluctuated significantly, the stability of AUC of LR and SVM machine learning algorithm prediction models continued to improve, and the AUC of RF machine learning algorithm prediction model was nearly 0.990, suggesting RF machine learning algorithm prediction model as the optimal machine learning algorithm prediction model. ② Optimization and evaluation of RF machine learning algorithm prediction model: 29 variables of predictive factors were sequentially introduced into the RF machine learning algorithm to construct the optimal RF machine learning algorithm prediction model in the training dataset. The results showed that when 10 variables were introduced, results of grid search method showed 4 as the optimal number of nodes in DT, and 1 000 as the optimal number of DT. When the number of introduced variables were not less than 10, the AUC of RF machine learning algorithm prediction model was about 0.990. When 10 variables were introduced, the RF machine learning algorithm prediction model had an AUC of 0.992 for postoperative overall survival of 3 years, a sensitivity of 0.629, a specificity of 0.996 in the training dataset, an AUC of 0.723 for postoperative overall survival of 3 years, a sensitivity of 0.177, a specificity of 0.948 in the validation dataset. (4) Construction and evaluation of COX nomogram prediction model. ① Analysis of postoperative survival factors of HCC patients in the training dataset. Results of univariate analysis showed that HBeAg, alpha fetoprotein (AFP), preoperative blood transfusion, maximum tumor diameter, liver capsule invasion, and degree of tumor differentiation were related factors for postoperative survival of HCC patients [ hazard ratio ( HR)=1.958, 1.878, 2.170, 1.188, 2.052, 0.222, 95% confidence interval ( CI): 1.185-3.235, 1.147-3.076, 1.389-3.393, 1.092-1.291, 1.240-3.395, 0.070-0.703, P<0.05]. Clinico-pathological data with P<0.2 were included for Lasso regression analysis, and the results showed that age, HBeAg, AFP, surgical procedure, perioperative blood transfusion, maximum tumor diameter, tumor located at liver segment Ⅴ or Ⅷ, liver capsule invasion, and degree of tumor differentiation as high differentiation, moderate-high differentiation, moderate differentiation, moderate-low differentiation were related factors for postoperative survival of HCC patients. The above factors were included for further multivariate COX analysis, and the results showed that HBeAg, surgical procedure, maximum tumor diameter were independent factors affecting postoperative survival of HCC patients ( HR=1.770, 8.799, 1.142, 95% CI: 1.049- 2.987, 1.203-64.342, 1.051-1.242, P<0.05). ② Construction and evaluation of COX nomogram prediction model: the clinicopathological factors of P≤0.1 in the COX multivariate analysis were induced to Rstudio software and rms software package to construct COX nomogram prediction model in the training dataset. The COX nomogram prediction model for predicting postoperative overall survival had an consistency index of 0.723 (se=0.028), an AUC of 0.760 for postoperative overall survival of 3 years in the training dataset, an AUC of 0.795 for postoperative overall survival of 3 years in the validation dataset. The verification of the calibration plot in the training dataset showed that the COX nomogram prediction model had a good prediction performance for postoperative survival. COX nomogram score=0.627 06×HBeAg (normal=0, abnormal=1)+ 0.134 34×maximum tumor diameter (cm)+ 2.107 58×surgical procedure (laparoscopy=0, laparotomy=1)+ 0.545 58×perioperative blood transfusion (without blood transfusion=0, with blood transfusion=1)-1.421 33×high differentiation (non-high differentiation=0, high differentiation=1). The COX nomogram risk scores of all patients were calculated. Xtile software was used to find the optimal threshold of COX nomogram risk scores. Patients with risk scores ≥2.9 were assigned into high risk group, and patients with risk scores <2.9 were assigned into low risk group. Results of Kaplan-Meier overall survival curve showed a significant difference in the postoperative overall survival between low risk group and high risk group of the training dataset ( χ2=33.065, P<0.05). There was a significant difference in the postoperative overall survival between low risk group and high risk group of the validation dataset ( χ2=6.585, P<0.05). Results of further analysis by the decision-making curve showed that COX nomogram prediction model based on the combination of HBeAg, surgical procedure, perioperative blood transfusion, maximum tumor diameter, and degree of tumor differentiation was superior to any of the above individual factors in prediction performance. (5) Evaluation of prediction performance between RF machine learning algorithm prediction model and COX nomogram prediction model: prediction difference between two models was investigated by analyzing maximun tumor diameter (the important variable shared in both models), and by comparing the predictive error curve of both models. The results showed that the postoperative 3-year survival rates predicted by RF machine learning algorithm prediction model and COX nomogram prediction model were 77.17% and 74.77% respectively for tumor with maximum diameter of 2.2 cm ( χ2=0.182, P>0.05), 57.51% and 61.65% for tumor with maximum diameter of 6.3 cm ( χ2=0.394, P>0.05), 51.03% and 27.52% for tumor with maximum diameter of 14.2 cm ( χ2=12.762, P<0.05). With the increase of the maximum tumor diameter, the difference in survival rates predicted between the two models turned larger. In the validation dataset, the AUC for postoperative overall survival of 3 years of RF machine learning algorithm prediction model and COX nomogram prediction model was 0.723 and 0.795, showing a significant difference between the two models ( t=3.353, P<0.05). Resluts of Bootstrap cross-validation for prediction error showed that the integrated Brier scores of RF machine learning algorithm prediction model and COX nomogram prediction model for predicting 3-year survival were 0.139 and 0.134, respectively. The prediction error of COX nomogram prediction model was lower than that of RF machine learning algorithm prediction model. Conclusion:Compared with machine learning algorithm prediction models, the COX nomogram prediction model performs better in predicting 3 years postoperative survival of HCC, with fewer variables, which is easy for clinical use.

Analysis of risk factors and related poor outcomes of first endotracheal extubation failure in early intubated very low birth weight and extremely low birth weight infants / 中华实用儿科临床杂志

Objective:To analyze the risk factors of first endotracheal extubation failure and the related poor outcomes of extubation failure in intubated very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.Methods:The VLBW/ELBW infants intubated in the first 24 hours, and admitted from June 2016 to December 2017 in Neonatal Intensive Care Unit of the Children′s Hospital of Fudan University were recruited in the study, and they were divided into 2 groups of the extubation-failure group and the extubation-success group based on whether being reintubated in 72 hours after the extubation.The clinical data of all children were collected, and risk factors and the short-term outcomes were compared between the 2 groups.Results:One hundred and twenty-six VLBW/ELBW infants including 25 extubation-failure infants and 101 extubation-success infants were recruited, the extubation fai-lure rate was 19.8%.Extubation-failure infants had lower gestational age and lower birth weight compared with those of extubation-success group [gestational age: (27.9±2.1) weeks vs.(28.9±1.6)weeks; birth weight: 990(847-1 200) g vs.1 170(1 060-1 350) g], and the differences were statistically significant (all P<0.05). The multiple Logistic analysis demonstrated that lower gestational age was the independent risk factor of extubation failure( OR=0.92, 95% CI: 0.86-0.99, P<0.05). The outcome analysis showed that the combined outcomes of moderate-to-severe bronchopulmonary dysplasia(BPD) and death in the extubation-failure group were significantly higher than those in the extubation-success group ( OR=3.33, 95% CI: 1.28-8.63, P<0.05)after being adjusted by gestational age.The secondary outcomes of brain magnetic resonance imaging(MRI) abnormality rate in the extubation-failure group was significantly higher compared with the extubation-success group ( OR=3.93, 95% CI: 1.22-12.60, P<0.05), and the mechanical ventilation duration was significantly longer as well in the extubation-failure group compared with that in the extubation-success group[10.1 d (6.9 d, 20.9 d) vs.3.6 d(1.1 d, 8.6 d)], and the difference was statistically significant( P<0.05). The rest secondary outcomes were not significantly different between the 2 groups(all P>0.05). Conclusions:A high rate of extubation failure in VLBW/ELBW infants was a common issue, and the lower gestational age is the independent risk factor for extubation failure.Extubation failure potentially increases the risk of moderate-to-severe BPD or death in VLBW/ELBW infants.

Antenatal corticosteroid therapy in late preterm infants: evidence and controversies / 中华围产医学杂志

Compared with term infants, late preterm infants, defined as the gestational age of 34 +0-36 +6 weeks, have a significantly higher incidence of neonatal respiratory diseases. Antenatal corticosteroid (ACS) therapy is of great importance in promoting lung maturation and improving prognosis in preterm infants. It has been recommended as a routine approach in the treatment of preterm infants less than 34 gestational weeks. However, its efficacy and potential side effects in late preterm infants remain inconclusive. We review the pharmaceutical mechanisms, clinical research data, current guidelines, controversies, potential complications of ACS therapy in late preterm birth to inform current clinical practice and address future research directions.

Influencing factors for the early recurrence of synchronous colorectal cancer liver metastases / 中华肝胆外科杂志

Objective:To investigate the definition and influencing factors of early recurrence after resection for synchronous colorectal cancer liver metastases (sCRLM).Methods:Patients with sCRLM in Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from December 2008 to December 2016 were included. Restricted cubic spline was used to determine the correlations between the time of recurrence and the long-term prognosis. The univariable and multivariable Cox was performed to measure the feasibility of recurrence within 6 months as the early recurrence. Then apply logistic regression, support vector machine, decision tree, random forest, artificial neural network and XGBoost, these machine learning algorithm to comprehensively rank the importance of every clinicopathological variable to early recurrence, and according to the comprehensively ranks, we introduced variables into the multivariable logistic regression model and observed the receiver operating characteristic curve (ROC) of the logistic regression model, based on the ROC area under curve, Akaike information criterion, and Bayesian information criterion, we identified the best performed variable combination and introduced them into the multivariate logistic regression analysis to confirm the independent risk factors for early recurrence. Subsequently, inverse probability weighting (IPTW) was performed on the therapy-associated independent risk factor to evaluate and validate its influence on the early recurrence of sCRLM patients after reducing the standardized mean difference of all covariates.Results:A total of 228 sCRLM patients who received resection were enrolled and followed up from 2.10 to 108.57 months. There were 142 males and 86 females, aged (55.89±0.67) years old. In 170 (74.6%) patients with recurrence, restricted cube analysis determined that the hazard ratio (HR) of disease free survival (DFS) and overall survival (OS) satisfies a linear relationship ( P<0.05), and Cox analysis indicated that 6 months as the time cutoff for defining early recurrence was feasible ( HR=3.405, 95% CI: 2.098-5.526, P<0.05). Early recurrence was occurred in 93 (40.79%) patients. The survival rate of patients in early recurrence group was significantly lower than that in the late recurrence group ( HR=3.405, 95% CI: 2.098-5.526, P<0.05, and the 5-year survival rate was 14.0% vs 52.0%). Comprehensive analysis of 6 machine learning algorithms identified that the total number of lymph node dissection >22 ( OR=0.258, 95% CI: 0.132-0.506, P<0.05) is an independent protective factor for early recurrence, while the number of liver metastases>3 ( OR=4.715, 95% CI: 2.467-9.011, P<0.05) and postoperative complications ( OR=2.334, 95% CI: 1.269-4.291, P<0.05) are independent risk factors. Finally, the IPTW analysis fully reduced the influence of covariate confounding influence via causal inference to prove lymph node dissection associated with early recurrence (IPTW OR=0.29, P<0.05), benefiting the DFS (IPTW HR=0.4887, P<0.05), but without influence on OS (IPTW HR=0.6951, P>0.05). Conclusion:Six months after sCRLM as the definition of early recurrence, it has significant feasibility. The long-term survival of patients with early recurrence is poor. The independent influencing factors of early recurrence after sCRLM are the total number of lymph node dissection, the number of liver metastases and postoperative complications disease.

Management of critically ill neonates with extracorporeal membrane oxygenation: analysis of nine cases / 中华围产医学杂志

Objective@#To assess the performance of extracorporeal membrane oxygenation (ECMO) in the treatment of neonates with critical diseases.@*Methods@#This study retrospectively analyzed the clinical data of nine critically ill neonates treated with ECMO because of cardiopulmonary failure due to respiratory disorders in Children's Hospital of Fudan University from August 2015 to April 2018. General information, diagnosis, indications and approaches of ECMO, clinical procedure of ECMO, laboratory results, weaning time, survival rate before discharge, length of stay, and mechanical and neurological complications were collected and described.@*Results@#(1) There were six male and three female patients with an average gestational age and body weight of 39.6 weeks (35-41 weeks) and 3 600 g (2 580-4 650 g), respectively. Out of them, six cases survived after successfully weaning from ECMO. (2) Sepsis (two cases), meconium aspiration (two cases), pulmonary hypertension (three cases), diaphragmatic hernia (one case) and pulmonary dysplasia (one case) were diagnosed in the patients. All underwent veno-arterial (VA) ECMO using centrifugal pump. The median age to initiate ECMO was 40 h (23-100 h) after birth, and the median duration of ECMO support was 240 h (70-370 h). During the treatment with ECMO, cholestasis, intracranial hemorrhage and vocal cord paralysis occurred in three cases, and mechanical complications (mainly were bleeding, hemolysis, oxygenated membrane leakage and embolization) occurred in five cases. The mean length of hospital stay for the six survivors was 24 d (20-49 d), and two of them developed neurological complications mainly manifested as cerebral infarction. There were three died cases. One was a baby with diaphragmatic hernia who received hernia repair during ECMO after which celiac space syndrome and necrotizing enterocolitis were developed and his parents refused further treatment. In the second case, the parents gave up treatment when no improvement was achieved after two weeks of ECMO support. While the last case was complicated by severe cerebral hemorrhage during ECMO and died after receiving no further treatment.@*Conclusions@#ECMO is newly applied in the treatment of neonates in China and of great significance for critically ill neonates. However, much need to be learned about its utilization in this population considering the mortality and disability rate are still high.

Comparative study of laparoscopic and open repair of gastroduodenal ulcer perforation / 国际外科学杂志

Objective To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation.Methods Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018,including 86 males and 31 females.The average age was 35.56 years with a range from 17 to 68 years.Patients were divided into two groups according to different surgical methods:laparoscopic group (n =56) and open group (n =61).Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer,while patients in the open group received open repair for perforated gastroduodenal ulcer.Comparison of two groups of patients with operation time,intraoperative blood loss,postoperative first anal exhaust time,analgesic utilization rate,length of hospital stay,the body's inflammatory response [preoperative and 24 h,72 h,120 h of postoperative peripheral white blood cell (WBC)],C-reactive protein level (CRP),postoperative complications (postoperative incision infection,incision dehiscence,gastric duodenal fistula,abdominal abscess,adhesion intestinal obstruction and lung infection).Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t-test was used for comparison between groups;count data were compared by Chi-square test.Results All the patients in the two groups successfully completed the operation,and there were no cases transferred to laparotomy in the laparoscopic group.Intraoperative blood loss [(15.3 ± 9.5) ml vs (30.5 ±11.3) ml,P ＜ 0.001],time of first anal exhaust [(56.5 ± 9.8) h vs (83.8 ± 15.6) h,P ＜ 0.001],analygesic utilization rate (10.71％ vs 52.46％,P ＜ 0.005),and length of hospital stay [(7.5 ± 1.5) d vs (10.0 ±3.4) d,P ＜ 0.001] of the laparoscopic group were significantly better in the open group,the differences were statistically significant.The WBC and CRP at 24 h,72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC:24 h,(14.55 ± 3.44) × 109/L vs (16.02 ± 4.12) × 109/ L,P =0.020;72 h,(10.25 ± 2.32) × 109/L vs (14.22 ± 3.29) × 109/L,P ＜ 0.001;120 h,(8.12 ±3.11) ×109/Lvs (11.58 ±2.33) × 109/L,P ＜0.001.CRP:24 h,(50.35 ± 13.73) mg/L vs (80.11 ±13.56) mg/L,P＜0.001;72 h,(29.37 ±7.81) mg/Lvs (53.57 ±8.05)mg/L,P＜0.001;120h,(17.71 ±7.01) mg/L vs (34.35 ± 7.72) mg/L,P ＜ 0.001],the differences were statistically significant.There was no significant difference in operation time and postoperative complications between the two groups (P ＞ 0.05).Conclusion Compared with open gastroduodenal ulcer perforation repair,laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller,and the body's inflammatory response are lighter,postoperative complications is no statistical significance,but will look from actual data,the cases of complications is less,is now a better surgical treatment of gastroduodenal ulcer perforation.

Management of critically ill neonates with extracorporeal membrane oxygenation: analysis of nine cases / 中华围产医学杂志

Objective To assess the performance of extracorporeal membrane oxygenation (ECMO) in the treatment of neonates with critical diseases.Methods This study retrospectively analyzed the clinical data of nine critically ill neonates treated with ECMO because of cardiopulmonary failure due to respiratory disorders in Children's Hospital of Fudan University from August 2015 to April 2018.General information,diagnosis,indications and approaches of ECMO,clinical procedure of ECMO,laboratory results,weaning time,survival rate before discharge,length of stay,and mechanical and neurological complications were collected and described.Results (1) There were six male and three female patients with an average gestational age and body weight of 39.6 weeks (35-41 weeks) and 3 600 g (2 580-4 650 g),respectively.Out of them,six cases survived after successfully weaning from ECMO.(2) Sepsis (two cases),meconium aspiration (two cases),pulmonary hypertension (three cases),diaphragmatic hernia (one case) and pulmonary dysplasia (one case) were diagnosed in the patients.All underwent veno-arterial (VA) ECMO using centrifugal pump.The median age to initiate ECMO was 40 h (23-100 h) after birth,and the median duration of ECMO support was 240 h (70-370 h).During the treatment with ECMO,cholestasis,intracranial hemorrhage and vocal cord paralysis occurred in three cases,and mechanical complications (mainly were bleeding,hemolysis,oxygenated membrane leakage and embolization) occurred in five cases.The mean length of hospital stay for the six survivors was 24 d (20-49 d),and two of them developed neurological complications mainly manifested as cerebral infarction.There were three died cases.One was a baby with diaphragmatic hernia who received hernia repair during ECMO after which celiac space syndrome and necrotizing enterocolitis were developed and his parents refused further treatment.In the second case,the parents gave up treatment when no improvement was achieved after two weeks of ECMO support.While the last case was complicated by severe cerebral hemorrhage during ECMO and died after receiving no further treatment.Conclusions ECMO is newly applied in the treatment of neonates in China and of great significance for critically ill neonates.However,much need to be learned about its utilization in this population considering the mortality and disability rate are still high.

Comparative study of laparoscopic and open repair of gastroduodenal ulcer perforation / 国际外科学杂志

Objective@#To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation.@*Methods@#Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018, including 86 males and 31 females. The average age was 35.56 years with a range from 17 to 68 years. Patients were divided into two groups according to different surgical methods: laparoscopic group (n=56) and open group (n=61). Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer, while patients in the open group received open repair for perforated gastroduodenal ulcer. Comparison of two groups of patients with operation time, intraoperative blood loss, postoperative first anal exhaust time, analgesic utilization rate, length of hospital stay, the body′s inflammatory response [preoperative and 24 h, 72 h, 120 h of postoperative peripheral white blood cell (WBC)], C-reactive protein level (CRP), postoperative complications (postoperative incision infection, incision dehiscence, gastric duodenal fistula, abdominal abscess, adhesion intestinal obstruction and lung infection). Measurement data were expressed as mean±standard deviation (Mean±SD), and t-test was used for comparison between groups; count data were compared by Chi-square test.@*Results@#All the patients in the two groups successfully completed the operation, and there were no cases transferred to laparotomy in the laparoscopic group. Intraoperative blood loss[(15.3±9.5) ml vs (30.5±11.3) ml, P<0.001], time of first anal exhaust[(56.5±9.8) h vs (83.8±15.6) h, P<0.001], analygesic utilization rate (10.71% vs 52.46%, P<0.005), and length of hospital stay [(7.5±1.5) d vs (10.0±3.4) d, P<0.001] of the laparoscopic group were significantly better in the open group, the differences were statistically significant. The WBC and CRP at 24 h, 72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC: 24 h, (14.55±3.44) ×109/L vs (16.02±4.12) ×109/L, P=0.020; 72 h, (10.25±2.32) ×109/L vs (14.22±3.29) ×109/L, P<0.001; 120 h, (8.12±3.11)×109/L vs (11.58±2.33) ×109/L, P<0.001. CRP: 24 h, (50.35±13.73) mg/L vs (80.11±13.56) mg/L, P<0.001; 72 h, (29.37±7.81) mg/L vs (53.57±8.05) mg/L, P<0.001; 120 h, (17.71±7.01) mg/L vs (34.35±7.72) mg/L, P<0.001], the differences were statistically significant. There was no significant difference in operation time and postoperative complications between the two groups (P>0.05).@*Conclusion@#Compared with open gastroduodenal ulcer perforation repair, laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller, and the body′s inflammatory response are lighter, postoperative complications is no statistical significance, but will look from actual data, the cases of complications is less, is now a better surgical treatment of gastroduodenal ulcer perforation.

Monitoring of cerebrospinal fluid dynamics in a model of brain herniation induced by acute intracranial hypertension by PC cine MRI / 中华急诊医学杂志

Objective To explore the monitoring of cerebrospinal fluid (CSF) dynamics in a model of brain herniation induced by acute intracranial hypertension in Guangxi Bama-Mini pigs by phasecontrast cine magnetic resonance imaging (PC cine MRI).Methods Femoral artery blood were extracted from 10 pigs,and injected into the frontal and temporal parietal lobe to make a model of brain herniation induced by acute intracranial hypertension.The mean arterial blood pressure (MAP),intracranial pressure (ICP),and cerebral perfusion pressure (CPP) were monitored.Routine T1WI,T2WI,coronal,sagittal and cerebrospinal fluid flow sequence (fast PC cine slice) which positioned on the cervical 3 (C3) vertebral body as the center and perpendicular to the spinal scans were performed on all experimental animals before and after blood injection with 3.0T Magnetic Resonance Imaging.The ICP,MAP,CPP,the absolute values of CSF peak flow velocity and the absolute value of carotid peak flow velocity before and after blood injection were compared.Results The ICP,MAP,CPP,and the absolute value of CSF peak flow velocity before injection of autologous arterial blood were statistically significant as compared with those after blood injection [(6.80±2.044) mmHg vs (52.20±1.619) mmHg,(76.80±7.068) mmHg vs (142.80±12.399) mmHg,(70.00±6.074) mmHg vs (90.50±12.250) mmHg,and the absolute value of CSF peak flow velocity was (243.20±77.671) mm/s vs (201.40±55.482) mm/s,respectively,P＜0.01].The absolute value of the peak velocity of the carotid artery before blood injection was not statistically significant compared with that after blood injection [(876.80±239.908) mm/s vs (799.40±241.829) mm/s,P＞0.05].Conclusion After the formation of brain herniation induced by acute intracranial hypertension,the CSF flow in the C3 level spinal canal showed a low dynamic change,and the CSF flow velocity waveform was disordered and malformed.The non-invasive measurement of CSF dynamics by PC cine MRI can provide an important basis for the change of CSF dynamics in the model of brain herniation induced by acute intracranial hypertension,and provide a theoretical basis for further research on damage control neurosurgery in the future.

Correlation between postoperative neutrophil to lymphocyte ratio and recurrence and prognosis of hepatocellular carcinoma after radical liver resection / 中华肿瘤杂志

Objective@#To investigate the correlation between postoperative peripheral blood neutrophil to lymphocyte ratio (NLR) and recurrence and prognosis of patients with hepatocellular carcinoma (HCC).@*Methods@#The clinicopathological and follow-up data of 344 patients with HCC who underwent radical liver resection from May 2010 to April 2014 were analyzed retrospectively.@*Results@#Of the 344 patients, 104 had early recurrence and 84 had late recurrence. Receiver operating characteristic (ROC) curve analysis showed that the NLR predicted area under the curve (AUC) of early recurrence was 0.622 (P<0.001), the optimal cut-off value was 2.41. The AUC of late recurrence was 0.634 (P=0.001), the optimal cut-off value was 2.15. Cox multivariate analysis showed the serum concentration of hepatitis B surface antigen (HR=2.508, 95% CI: 1.311-4.798), microvascular invasion (HR=2.422, 95% CI: 1.239-4.734), Milan criteria (HR=2.373, 95% CI: 1.427-3.948) and postoperative NLR (HR=2.285, 95% CI: 1.379-3.788) were independent risk factors of early recurrence after HCC resection. Postoperative NLR (HR=2.927, 95% CI: 1.630-5.255), liver cirrhosis (HR=2.531, 95% CI: 1.291-4.962) and serum concentration of albumin (HR=2.257, 95% CI: 1.251-4.073) were independent risk factors of late recurrence after HCC resection. The median recurrence-free survival (RFS) of the 344 patients was 45.0 months, and the median overall survival (OS) was 63.2 months. ROC curve analysis showed that the postoperative NLR predicted 5-year survival AUC was 0.689 (P<0.05), with an optimal cutoff of 2.29. Cox multivariate analysis showed microvascular invasion (HR=2.247, 95% CI: 1.534-3.291), postoperative NLR (HR=2.217, 95% CI: 1.653-2.974), and liver cirrhosis (HR=1.685, 95% CI: 1.168-2.431), Milan criteria (HR=1.679, 95% CI: 1.238-2.277), serum concentration of hepatitis B surface antigen (HR=1.623, 95% CI: 1.102-2.392), serum concentration of albumin (HR=1.43, 95% CI: 1.066-1.918) were independent factors of RFS after HCC resection, while microvascular invasion (HR=3.862, 95% CI: 2.407-6.197), Barcelona staging (HR=2.864, 95% CI: 1.600-5.125), postoperative NLR (HR=2.688, 95% CI: 1.782-4.055), liver cirrhosis (HR=2.039, 95% CI: 1.184-3.514), serum concentration of albumin (HR=1.81, 95% CI: 1.204-2.720) were independent factors of OS.@*Conclusions@#For HCC patients who receive radical liver resection, postoperative NLR ≥2.29 implicates poor prognosis. Moreover, postoperative NLR ≥2.41 suggests early recurrence, while NLR ≥2.15 suggests late recurrence.

Clinical features of and treatment strategies for primary retroperitoneal neurofibromas: clinical analysis of 7 cases / 中华普通外科杂志

Objective To investigate the clinical features,diagnosis and treatment strategies for primary retroperitoneal neurofibromas.Methods The clinical data of 7 patients with primary retroperitoneal neurofibromas admitted to Cancer Institute & Hospital,Chinese Academy of Medical Sciences,from Jan 2000 to Jul 2017,were retrospectively analyzed.Results The average age was (42 ± 11) years and six were female.6 cases were with solitary tumor and 1 case was with multiple tumors.Clinical symptoms and imaging were of no help in determining tumor type.All patients underwent surgical resection.Postoperative pathology confirmed retroperitoneal neurofibroma in all seven patients,including 1 case with neurofibromatosis type Ⅰ and retroperitoneal malignant peripheral nerve sheath tumor.On immunohistochemistry all of the tumors were S-100 protein positive.At the end of the follow-up period ranging from 14 months to 166 months,sevent patients were alive and two patients experienced tumor recurrence.The longest disease-free survival time was 166 months.Conclusion Primary retroperitoneal neurofibromas are a rare type of primary retroperitoneal tumors that require diagnosis at pathology.Clinical symptoms and imaging of primary retroperitoneal neurofibromas patients were found to be ineffective at determining tumor type.Patients had a good prognosis after tumor resection.

A correlation study of necrotizing enterocolitis and encephalopathy of prematurity in premature infants with gestational age ＜ 32 weeks / 中国新生儿科杂志

Objective To study the correlation of necrotizing enterocolitis (NEC) and encephalopathy of prematurity (EOP) in premature infants with gestational age (GA) ＜ 32 weeks.Method From January 2009 to December 2014,clinical data of preterm infants (GA ＜ 32 weeks) admitted to department of neonatology of Children's Hospital of Fudan University and received brain magnetic resonance imaging (MRI) at corrected GA of full term or near full term were collected.NEC patients were assigned into the NEC group.At the same time,patients with similar GA and birth weight without NEC were assigned into the control group.The incidence and MRI characteristics of EOP were studied using Chi-square method.Result A total of312 preterm infants were included in our study,104 in the NEC group,and 208 in the control group.The incidence of EOP in the NEC group was higher than the control group (27.9％ vs.17.3％).The difference between the two groups were statistically significant (P =0.030).The incidence of non-cystic EOP in the NEC group was significantly higher than the control group (89.7％ vs.63.9％,P =0.017).Conclusion NEC and EOP may be correlated in preterm infants with GA ＜32 weeks.Most of EOP were non-cystic injury.

Complications of extracorporeal membrane oxygenation in neonates / 中国小儿急救医学

Extracorporeal membrane oxygenation(ECMO)is an important cardiopulmonary support technique.It is the ultimate treatment for heart failure and lung failure after conventional treatment.ECMO enables the body to temporarily replace the pulmonary function and part of the heart function by extracorpore-al gas exchange,and creates a time window for the recovery of respiratory or cardiac function. In 1974, ECMO was first used in neonates.There are many complications in the application of ECMO in neonates, including mechanical complications,bleeding and thrombosis,hemolysis,neurological complications,renal dysfunction,gastrointestinal complications,infection,etc.Long term follow-up found that growth and develop-ment are affected by varying degrees. Timely monitoring,identification of complications and appropriate treatment will improve outcomes.

Comparison of effectiveness between two different modes of surgical intervention for the treatment of intracerebral hemorrhage in hypertensive patients / 中华急诊医学杂志

Objective To study the efficacy of two different modes of surgical intervention for the treatment of hypertensive intracerebral hemorrhage (HICH):YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction versus conventional craniectomy plus hematoma evacuation.Methods Medical records of 23 patients with HICH treated from December 2012 to February 2017 were retrospectively analyzed.The differences in demographics,length of operation time,costs and length of hospital stay,Glasgow Outcome Scale scores and 3-month follow-up results were compared between the YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction in 12 patients and conventional craniectomy plus hematoma evacuation in 11 patients.Results There were no significant differences in the gender (male 58.33％ vs.63.64％,femal 41.67％ vs.36.36％),age (65.5±11.8 years vs.56.8±10.1 years),preoperative GCS (6.83±3.93 vs.5.82±3.40),intracranial hematoma volume (50.52±23.07 mL vs.68.77±11.18 mL) and length of hospital stay (15.58±14.72 days vs.22.45±18.37 days) (P＞0.05);There were statistically significant differences in length of operation time (0.73±0.21 h vs.3.92±0.67 h) and hospitalization costs (45 230.50±36 566.88 yuan of RMB vs.79 857.90±34 916.48 yuan of RMB) between two groups (P＜0.05);Follow-up 3 months,there were no significant differences in rate of good recovery 33.3％ vs.18.1％,severe disability rate (25.0％ vs.27.3％) and mortality rate (41.7％ vs.54.6％) between two groups (P＞0.05).Conclusions The minimally invasive YL-1 type hematoma aspiration procedure with bio-enzyme liquefaction as a minimally invasive surgery may be superior to conventional craniectomy for treating HICH because it can offer shorter operation time,more accurate hematoma localization,lower risk of injury,and lower hospitalization costs.In particular,the procedure is suitable for elderly,frail,and poor general condition patients.It can also be applied as emergency treatment for HICH.

A new prognostic score system of hepatocellular carcinoma following hepatectomy / 中华肿瘤杂志

Objective@#To establish a new scoring system based on the clinicopathological features of hepatocellular carcinoma (HCC) to predict prognosis of patients who received hepatectomy.@*Methods@#A total of 845 HCC patients who underwent hepatectomy from 1999 to 2010 at Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. 21 common clinical factors were selected in this analysis. Among these factors, the cut-off values of alpha-fetoprotein (AFP), alkaline phosphatase (ALP) and intraoperative blood loss were evaluated by using a receiver operating characteristic (ROC) curve analysis.The Kaplan-Meier method and Cox regression model were used to evaluate the independent risk factors associated with the prognosis of HCC patients after hepatectomy. HCC postoperatively prognostic scoring system was established according to the minimum weighted method of these independent risk factors, and divided the patients into 3 risk groups, including low-risk, intermediate-risk and high-risk group. The relapse-free survival (RFS) and overall survival (OS) were compared among these groups.@*Results@#The univariate analysis showed that clinical symptoms, preoperative α-fetoprotein (AFP) level, serum alkaline phosphatase (ALP) level, tumor size, tumor number, abdominal lymph node metastasis, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, the severity of hepatic cirrhosis, intraoperative blood loss, the liver operative method, pathological tumor thrombus, intraoperative blood transfusion, perioperative blood transfusion were significantly associated with median RFS of these HCC patients (P<0.05). Alternatively, clinical symptoms, preoperative AFP level, serum ALP level, tumor size, tumor number, abdominal lymph node metastasis, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, the severity of hepatic cirrhosis, intraoperative blood loss, the liver operative method, pathological lymphocyte invasion, pathological tumor thrombus, intraoperative blood transfusion, perioperative blood transfusion were significantly associated with the median OS of these HCC patients (P<0.05). The multivariate analysis showed that AFP ≥20 ng/ml, clinical symptoms, tumor diameter ≥5 cm, multiple tumors, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, moderate and severe liver cirrhosis, non- anatomic resection were the independent risk factors of RFS and OS (P<0.05). The independent risk factor of RFS was intraoperative bleeding loss ≥325 ml (P<0.05); The independent risk factors of OS were abdominal lymph node metastasis and pathological tumors thrombus (P<0.05). The respective weight of 11 independent factors was used to establish the scoring system (scores range from 0 to 26). In the score system, 0 to 5 points were defined as the low-risk group (286 cases), 6 to 12 points were determined as the intermediate-risk group (503 cases), more than 13 points were classified as the high-risk group (56 cases). The median RFS of the low-risk, intermediate-risk and high-risk group were 80, 27 and 6 months, respectively. The differences were statistically significant (P<0.001). The median OS of the three groups were 134, 51 and 15 months, respectively, and the differences were statistically significant (P<0.001).@*Conclusion@#This new score system provides effective prediction of postoperative prognosis for HCC patients.