ABSTRACT
Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.
ABSTRACT
Wastewater based surveillance has gained prominence and come to the forefront as a leading indicator of forecasting COVID-19 infection dynamics owing to its cost-effectiveness and its ability to inform early public health interventions. A university campus could especially benefit from wastewater surveillance as they are characterized by largely asymptomatic populations and are potential hotspots for transmission that necessitate frequent diagnostic testing. In this study, we employed a large-scale GIS (Geographic information systems) enabled building-level wastewater monitoring system associated with the on-campus residences of 7614 individuals. Sixty-eight automated wastewater samplers were deployed to monitor 239 campus buildings with a focus on residential buildings. Time-weighted composite samples were collected on a daily basis and analyzed within the same day. Sample processing was streamlined significantly through automation, reducing the turnaround time by 20-fold and exceeding the scale of similar surveillance programs by 10 to 100-fold, thereby overcoming one of the biggest bottlenecks in wastewater surveillance. An automated wastewater notification system was developed to alert residents to a positive wastewater sample associated with their residence and to encourage uptake of campus-provided asymptomatic testing at no charge. This system, integrated with the rest of the "Return to Learn" program at UC San Diego-led to the early diagnosis of nearly 85% of all COVID-19 cases on campus. Covid-19 testing rates increased by 1.9-13X following wastewater notifications. Our study shows the potential for a robust, efficient wastewater surveillance system to greatly reduce infection risk as college campuses and other high-risk environments reopen. IMPORTANCEWastewater based epidemiology can be particularly valuable at University campuses where high-resolution spatial sampling in a well-controlled context could not only provide insight into what affects campus community as well as how those inferences can be extended to a broader city/county context. In the present study, a large-scale wastewater surveillance was successfully implemented on a large university campus enabling early detection of 85% of COVID-19 cases thereby averting potential outbreaks. The highly automated sample processing to reporting system enabled dramatically reduced the turnaround time to 5h (sample to result time) for 96 samples. Furthermore, miniaturization of the sample processing pipeline brought down the processing cost significantly ($13/sample). Taken together, these results show that such a system could greatly ameliorate long-term surveillance on such communities as they look to reopen.
ABSTRACT
Objective The aims of this study were to compare the different expression between high-risk human papilloma-virus load(HR-HPV DNA)and Th1/Th2 type cytokines in local different microenvironments of cervix,and to explore the possibility and significance of predicting cervical cancer. Methods A total of 339 patients with persistent HR-HPV infection were divided into cervical intraepithelial neoplasia(CIN)and cervical cancer. Forty patients with HPV-negative and cytological examination of normal cervix were used as controls. PCR fluorescence assay and double antibody sandwich were used. ELISA assay were used to detect HPV-DNA and Th1 type cytokines including IL-2,IFN-γ,TNF-ɑ and Th2 type cytokines including IL-4,IL-6 and IL-10 from cervical secretion. The ratio of TNF-ɑ/IL-10 was used as an index to measure the immune balance of Th1/Th2. Univariate and multivariate logistic regression were performed to analyze the data and then to screen the predicting indicators of cervical cancer. Results Univariate analysis showed that HR-HPV DNA,IL-2,IL-4,IL-6,IL-10,IFN-γ,TNF-ɑ and TNF-ɑ/IL-10 were significantly different between CIN and cervical cancer groups(P<0. 05),which could be used as a risk factor for predicting cervical cancer. Multivariate logistic regression analysis showed that IL-10,IFN-γ,TNF-ɑ,TNF-ɑ/IL-10 were the influencing factors of cervical cancer. The regression model fitted goodness test was Nagelkerke(R2= 0. 982),the pre-judgment rate for CIN was 99. 5% ,the pre-judgment rate of cervical cancer was 100% ,and the total positive rate was 99. 7% ,suggesting good fitting effect was good and the prediction accuracy was high. Conclusion CINⅠand CINⅡhave abnormal expression of Th cytokine,but they do not affect Th1/Th2 balance. Th1/Th2 imbalance in CINⅢ stage and Th2 dominant expression promote the occurrence of cervical cancer. Based on the regression model for predicting cervical carcinogenesis,cervical immunity caused inhibitory microenvironment by local immune imbalance is the key link in HR-HPV persistent infection and cervical cancer,and has nothing to do with HR-HPV DNA.
ABSTRACT
ObjectiveTo explore and analyze the effect of simulation-based learning combined with debriefing in neonatal resuscitation training.MethodsA total of 114 clinical medical staffs attended the neonatal resuscitation training course hold by Department of Neonatology, Quzhou Maternal and Child Health Hospital from November 2014 to May 2015, and were randomly assigned to observation (n=60) and control group (n=84) by coin tossing. Staffs in the observation group adopted to training skills with simulation-based learning combined with debriefing,while those in the control group were educated with traditional method. The examinations on theoretical knowledge were taken before and after the training. Operational exam and self-confident questionnaire for all staffs on each procedure taught in the course were taken at last. Scores of the exams and self-confident questionnaire were compared between the two groups witht-test and Mann-WhitneyU test.ResultsThe mean score of theoretical test rose up significantly after the training in both observation and control group (25.19±2.62 vs 20.17±3.71,t=7.725,P<0.01; 25.44±2.64 vs 18.90±4.27,t=11.170,P<0.01), but no difference was found in this score after the training between the two groups (t=0.492,P=0.624). The practical operation examination score in the observation group was higher than that in the control (34.05±1.34 vs 31.32±4.10,t=4.183,P<0.01). All questionnaires sent to the staffs were retrieved (100%), and the total values after the training in the observation group were higher than in the control (mean rank: 92.81 vs 57.99; rank sum:5 569 vs 4 872,Z=-4.96,P<0.01).ConclusionsSimulation-based learning combined with debriefing is a much more effective teaching methods for neonatal resuscitation training, which might quickly improve the resuscitation skills of clinical staffs.
