Objective To study the clinical features and prognosis of meconium aspiration syndrome (MAS) complicated by neonatal pulmonary hemorrhage (NPH) in neonates. Methods A retrospective analysis was performed for the clinical data of 45 neonates with MAS complicated by NPH who were admitted to the hospital from December 2015 to December 2018 (observation group). Ninety neonates with MAS who were hospitalized during the same period of time and had no pulmonary hemorrhage were enrolled as the control group. The two groups were compared in terms of clinical features and prognosis. Results The observation group had a significantly lower 1-minute Apgar score after birth than the control group (P < 0.05). Compared with the control group, the observation group had significantly higher incidence rates of persistent pulmonary hypertension of the newborn, air leak syndrome and shock and a higher rate of use of pulmonary surfactant (P < 0.05), as well as higher levels of C-reactive protein and oxygen index (OI) (P < 0.01). In the early diagnosis of NPH, OI had a sensitivity of 80.0%, a specificity of 96.7%, and an area under the receiver operating characteristic curve of 0.959 (95% confidence interval:0.929-0.988, P < 0.001) at the cut-off value of 10.05. For the children who were cured and discharged, the observation group had significantly longer duration of ventilation, duration of oxygen inhalation and length of hospital stay than the control group (P < 0.05). Conclusions Neonates with MAS complicated by NPH tend to have a longer duration of ventilation and higher incidence rates of air leak syndrome and shock. OI may be used as an index for the early diagnosis of MAS complicated by NPH.

Objective To investigate the risk factors for poor prognosis of neonatal bacterial meningitis. Methods A retrospective analysis was performed for the clinical data of 152 children with neonatal bacterial meningitis. According to their prognosis, they were divided into a good prognosis group with 122 children and a poor prognosis group with 30 children. The two groups were compared in terms of general status, initial symptoms, and laboratory findings, and the risk factors for poor prognosis were analyzed. Results Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of children with a very low birth weight, a peripheral blood white blood cell count (WBC) of < 5×10⁹/L or > 20×10⁹/L, a C-reactive protein level of > 50 mg/L, a cerebrospinal fluid (CSF) WBC of > 500×10⁶/L, a CSF glucose level of < 1 mmol/L, or a CSF protein level of > 2 g/L, as well as significantly higher positive rates of blood culture and/or CSF culture, Gram-positive bacteria, and Streptococcus agalactiae (P < 0.05). The multivariate logistic regression analysis showed that a CSF glucose level of < 1 mmol/L and a CSF protein level of > 2 g/L were independent risk factors for poor prognosis of neonatal bacterial meningitis. Conclusions A CSF glucose level of < 1 mmol/L and a CSF protein level of > 2 g/L are risk factors for poor prognosis of neonatal bacterial meningitis.

Objective To study the long-term prognosis of vesicoureteral reflux in children. Methods A retrospective analysis was performed for the clinical data of 138 children (218 ureters with reflux) who were diagnosed with vesicoureteral reflux for the first time from November 2005 to March 2017 and received medical treatment and regular follow-up. According to the initial grade of reflux, the ureters with reflux were divided into a low-grade group (141 ureters, grade I-III) and a high-grade group (77 ureters, grade IV-V), and the two groups were compared in terms of clinical data and follow-up results. Results Among the 138 children, there were 82 boys and 56 girls. Their age ranged from 31 days to 10 years at the time of confirmed diagnosis, with a median age of 8 months. The follow-up time ranged from 8 months to 7 years, with a median follow-up time of 1.4 years. At the time of confirmed diagnosis, the high-grade group had significantly higher levels of urinary N-acetyl-β-D-glucosaminidase, urinary microalbumin and urinary immunoglobulin G than the low-grade group (P < 0.05). Among the 218 ureters with reflux, 132 (60.6%) achieved a reduction in the grade of reflux (among which 74 achieved complete disappearance of reflux), 43 had no change in the grade of reflux, and 43 had an increase in the grade of reflux. Compared with the high-grade group, the low-grade group had a significantly higher complete remission rate (41.1% vs 19.5%, P=0.001) and a significantly shorter time to complete remission of reflux (P=0.002). Conclusions Most children with vesicoureteral reflux can achieve a reduction in the grade of reflux or even complete disappearance of reflux during follow-up, and the children with low-grade reflux have better prognosis than those with high-grade reflux.

Objective To study the clinical effect of the SCMC APL-2010 regimen in the treatment of acute promyelocytic leukemia (APL) in children. Methods A retrospective analysis was performed for the clinical data of 44 children with APL who received treatment with the SCMC APL-2010 regimen between April 2010 and July 2016. The Kaplan-Meier survival analysis was used to evaluate event-free survival (EFS) rate and overall survival (OS) rate. Results Of the 44 children with APL, 42 (95%) achieved a complete remission (CR) after one course of treatment and 1 achieved CR after two courses of treatment, with an overall CR rate of 98%. The 9-year EFS and OS rates were 96%±3% and 97.7%±2.2% respectively. As for adverse events, 41 (93%) had infection, 29 (66%) had granulocyte reduction, 12 (27%, 1 died) had differentiation syndrome, 16 (36%) had liver dysfunction, 12 (27%) had adverse gastrointestinal reactions, and 7 (16%) had QT prolongation, 1 (2%) had orchitis, and no secondary neoplasm was observed. Conclusions Children with APL receiving the SCMC APL-2010 regimen have a good prognosis and can achieve a long-term survival, while treatment-related infection is commonly seen.

Objective To study the value of red blood cell distribution width (RDW)-to-platelet count (PLT) ratio (RPR) on the first day of admission into the pediatric intensive care unit (PICU) in predicting the prognosis of children with sepsis. Methods A retrospective analysis was performed for the clinical data of 186 children with sepsis who were hospitalized in the PICU. According to their prognosis, they were divided into a survival group with 151 children and a death group with 35 children. Clinical data were compared between the two groups. The Cox proportional-hazards regression model analysis was used to investigate the factors influencing the prognosis. The receiver operating characteristic (ROC) curve was plotted to evaluate the value of RPR in predicting death. The children were divided into a high RPR group and a low RPR group according to the optimal cut-off value, and the Kaplan-Meier method was used to compare the 28-day survival rate between the two groups. Results Compared with the survival group, the death group had significantly higher RDW, procalcitonin (PCT) and RPR (P < 0.05) and significantly lower PLT and albumin (ALB) (P < 0.05). The Cox regression model analysis showed that low ALB, high PCT and high RPR were independent risk factors for the prognosis of children with sepsis (P < 0.05). The ROC curve analysis showed that RPR had a certain value in predicting the prognosis of children with sepsis (P < 0.05), with an area under the ROC curve of 0.937, an optimal cut-off value of 0.062, a sensitivity of 94.29%, and a specificity of 77.48%. The Kaplan-Meier survival analysis showed that the high RPR group had a significantly lower 28-day survival rate than the low RPR group (P < 0.05). Conclusions RPR on the first day of admission into the PICU is closely associated with the prognosis of children with sepsis and has an important value in predicting the prognosis of children with sepsis.

Objective To study the change in P wave on electrocardiogram and its diagnostic value in children and adolescents with cardioinhibitory vasovagal syncope (VVS-CI). Methods A total of 43 children and adolescents who were diagnosed with VVS-CI were enrolled as the VVS-CI group, and 43 healthy children and adolescents were enrolled as the control group. P wave duration and P wave voltage were measured by 12-lead electrocardiography in a basal state, and the changes were analyzed. Results Compared with the control group, the VVS-CI group had a significantly lower heart rate (P < 0.05) and significantly longer P wave duration (Pwd), P wave maximum duration (Pmax), and corrected P wave maximum duration (Pcmax), as well as significantly higher P wave dispersion (Pd) and corrected P wave dispersion (Pcd) (P < 0.05). Pwd, Pmax, Pd, Pcmax and Pcd had a certain diagnostic value in children and adolescents with VVS-CI (P < 0.05):Pwd had a sensitivity of 69.77% and a specificity of 83.72% at the optimal cut-off value of 78.49 ms; Pmax had a sensitivity of 76.74% and a specificity of 90.70% at the optimal cut-off value of 93.39 ms; Pd had a sensitivity of 95.35% and a specificity of 69.77% at the optimal cut-off value of 27.42 ms; Pcmax had a sensitivity of 46.51% and a specificity of 88.37% at the optimal cut-off value of 120.90 ms; Pcd had a sensitivity of 83.72% and a specificity of 72.09% at the optimal cut-off value of 36.37 ms. Conclusions Children and adolescents with VVS-CI have significantly increased Pwd, Pmax, Pd, Pcmax, and Pcd, which may indicate abnormal atrial electrical activity. The cut-off value of P wave has a certain diagnostic value in VVS-CI.

Objective To investigate the current status of neglect in children aged 3-6 years in the rural areas of Urumqi, China and risk factors for neglect. Methods Stratified random cluster sampling was performed to select 1 326 children, aged 3-6 years, from 6 kindergartens in the rural areas of Urumqi. A self-designed questionnaire and "Chinese Neglect Evaluation Questionnaire for Rural Children Aged 3-6 Years" were used for investigation. Results Of the 1326 children, the neglect rate was 51.89% (688 cases), and the degree of neglect was 49±6. There were significant differences in the neglect rate and the degree of neglect between the children in different age groups (P < 0.01). The single-parent families and the remarried families had significantly higher child neglect rate and degree of neglect than the families of three generations under one roof and the core families (P < 0.01). The children in left-behind status had a significantly higher degree of neglect (P < 0.01). The multivariate logistic regression analysis showed that younger children, mothers with low education level, employment status of the mother as a migrant worker, single-parent and remarried families, low-income families, and left-behind status were risk factors for child neglect (P < 0.05). Conclusions The neglect of children aged 3-6 years in the rural areas of Urumqi is serious, and more attention should be paid to younger children, children whose mothers with low education level, left-behind children, and children from single-parent families, remarried families and low-income families.

An 11-year-old girl was found to have pale complexion and anemia with gradual aggravation for one year. She was weak in the past and developed pneumonia in the right middle lung 3-5 times per year, which was improved after anti-infective therapy. She and her mother had congenital deaf-mutism. Physical examination showed the appearance of anemia, without bleeding, jaundice, hepatosplenomegaly, or lymph node enlargement. Routine blood test results showed reductions in all three blood cell lines, normocytic anemia, and megaloblastoid change in granulocytic and erythroid cell lines in bone marrow, with no obvious increase in primitive cells or metastatic tumor cells. Whole exome sequencing indicated the presence of a known pathogenic mutation for Emberger syndrome (ES), c.1084C > T (p.Arg362^*) in the GATA2 gene. The girl was finally diagnosed with ES, and myelodysplastic syndrome (MDS) progressed to acute myeloid leukemia during follow-up. ES is a rare type of MDS with autosomal dominant inheritance in clinical practice, and it is difficult to make a confirmed diagnosis. ES should be considered for children with unexplained lymphedema and congenital deafness, and gene detection should be performed to make a confirmed diagnosis.

Objective To study the effect of PR-957 on the formation of A1 reactive astrocytes. Methods The cerebral cortices of 1-day-old female rats were obtained and cultured for primary astrocytes. These cells were divided into 3 groups:control, lipopolysaccharide (LPS), and LPS+PR-957. The LPS group was treated with LPS (at a concentration of 5 μmol/L) for 48 hours; the LPS+PR-957 group was treated with PR-957 (at a final concentration of 200 nmol/L) for 1 hour and then LPS for 48 hours. Enzyme-linked immunosorbent assay was used to determine the expression of complement 3 (C3, a marker for A1 reactive astrocytes) and tumor necrosis factor alpha (TNF-α). Quantitative real-time PCR was used to determine the relative mRNA expression of glypican-6 (GPC6), SPARC-like 1 (SPARCL1), and lipocalin-2 (LCN2). All the above experiments were repeated three times independently. Results C3 expression was almost not observed in the control group, but was observed in both the LPS group and the LPS+PR-957 group, with significantly lower expression observed in the LPS+PR-957 group (P < 0.05). The expression of TNF-α was consistent with that of C3. Compared with the control group, the LPS and the PS+PR-957 groups had significantly reduced mRNA expression levels of GPC6 and SPARCL1 but significantly increased mRNA expression level of LCN2 (P < 0.001). Compared with the LPS group, the LPS+PR-957 group had significantly increased mRNA expression levels of GPC6 and SPARCL1 but significantly reduced mRNA expression level of LCN2 (P < 0.001). Conclusions LPS can induce the transformation from astrocytes to A1 reactive astrocytes, and PR-957 can inhibit the formation of LPSinduced A1 reactive astrocytes.

Objective To investigate the effects of calcium-sensitive receptors (CaSR) on the expression of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) and cortisol concentration in a neonatal mouse model of persistent pulmonary hypertension (PPH). Methods Fifty-six newborn C57BL/6 mice were randomly divided into a control group (n=14), a PPH group (n=14), an agonist group (n=14), and an inhibitor group (n=14). The mice in the PPH, agonist, and inhibitor groups were exposed to a 12% oxygen concentration, and the agonist group and inhibitor group were given CaSR agonist (GdCl3, 16 mg/kg) and CaSR antagonist (NPS2390, 1 mg/kg) intraperitoneally once a day, respectively. The mice in control group were exposed to air, and then injected with an equal volume of normal saline as those in the PPH group every day. All mice were treated for 14 days. Morphological examination of heart and lung tissues was performed using hematoxylin-eosin staining. The expression levels of 11β-HSD2 mRNA and 11β-HSD2 protein in lung tissues were measured by qRT-PCR and Western blot respectively. Brain natriuretic peptide (BNP) and cortisol levels in lung tissues were determined using ELISA. Results Compared with the control group, the PPH group had significantly increased pulmonary artery wall thickness (WT%), ratio of right to left ventricular thickness (RV/LV), alveolar mean linear intercept, and BNP concentration and a significantly reduced radial alveolar count (P < 0.05); compared with the PPH group, the agonist group showed significant increases in WT% and BNP concentration, while the inhibitor group showed significant reductions in the two indicators (P < 0.05). Compared with the control group, the PPH group showed significant reductions in the expression levels of 11β-HSD2 mRNA and 11β-HSD2 protein, but a significant increase in cortisol concentration (P < 0.05); compared with the PPH group, the agonist group had significantly lower expression levels of 11β-HSD2 mRNA and 11β-HSD2 protein, but a significant higher cortisol concentration, while the inhibitor group showed opposite changes in these indicators (P < 0.05). Conclusions CaSR may control the development and progression of PPH in newborn mice by regulating the expression of 11β-HSD2 and cortisol concentration.

MicroRNA (miRNA) is a non-coding single-stranded RNA with a length of approximately 22 nucleotides and is mainly responsible for the regulation of gene expression at the post-transcriptional level. At present, miRNA have become potential biomarkers for various diseases such as tumor, leukemia, and nervous system disease. Muscle-specific microRNAs are enriched in the skeletal muscle of patients with Duchenne muscular dystrophy (DMD) and also play an important role in the pathogenesis of DMD. Creatine kinase has limited specificity in the diagnosis of DMD since its level is not significantly associated with disease severity, and therefore, it is of great clinical significance to explore whether muscle-specific microRNAs can be used as ideal biomarkers for DMD. This article reviews the research advances in this field.