To investigate the clinical characteristics, genetic features, and follow-up outcomes of children with MECP2 gene mutations.

A retrospective analysis was conducted on the clinical data of 15 children with MECP2 gene mutations diagnosed by molecular testing at the First Affiliated Hospital of Anhui Medical University from October 2017 to March 2025. Data collected included general information, clinical phenotypes, auxiliary examination results, treatment, and follow-up records. Whole-exome sequencing (WES) was performed to detect gene mutations in the children and their parents, with Sanger sequencing for verification and pedigree co-segregation analysis. Pathogenicity grading was performed according to the American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines, combined with RTT diagnostic criteria and clinical staging for comprehensive evaluation. This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Approval No. PJ-2024-12-62), and all legal guardians of the subjects provided written informed consent.

① Among the 15 children, 11 were female and 4 were male. Ten cases met the diagnostic criteria for typical RTT, three were atypical RTT, and two did not meet the RTT diagnostic threshold (one case with pervasive developmental delay and regression, and one with autism spectrum disorder). All typical RTT cases exhibited developmental regression, loss of hand function and language ability, and associated with hand stereotyped movements. Male children showed significant clinical phenotypic heterogeneity. ②At initial diagnosis, six cases had coexisting epilepsy, two had only abnormal electroencephalogram (EEG), and three of the seven with normal EEG developed epilepsy during the course of the disease. At initial diagnosis, 2 cases exhibited abnormal cranial MRI findings. Among the 15 pediatric patients, 5 cases had nonsense mutations, 4 cases had missense mutations, 4 cases had frameshift/splicing site mutations, and 2 cases had copy number variations (CNV). Of these, 12 cases presented with novel mutations, and 3 cases were maternally inherited. According to the ACMG/AMP guidelines, all identified mutations were classified as pathogenic (L) or potentially pathogenic (LP), including a frameshift mutation (p.L383Profs*5) reported for the first time in this study. Among the 13 RTT patients, 10 were in stage Ⅱ at initial diagnosis, and 3 were in stage Ⅰ. Follow-up ranged from 2 to 96 months. Three male patients died, all exhibiting rapid disease progression with severe complications. The disease progression in 9 RTT patients was observed over time, with 1 case showing no progression and 2 cases with stable conditions (non-RTT). Among the 9 cases finally diagnosed with epilepsy, 3 cases were refractory epilepsy with poor prognosis, 4 cases had well-controlled epilepsy, and 2 cases had controlled epilepsy after short-term follow-up.

MECP2 gene mutations are associated with significant clinical phenotypic heterogeneity. Female patients predominantly present with classic RTT phenotypes, while male patients exhibit rapid disease progression and poor prognosis, manifesting as developmental delay or severe fatal encephalopathy. Epilepsy control is correlated with the degree of functional preservation.

To explore the clinical characteristics and maternal and fetal outcomes of pregnant women with malignant tumors.

A total of 30 455 women with singleton pregnancies who delivered at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between January 2020 and December 2024 were enrolled in this study, including 385 cases complicated by malignancy. According to the presence or absence of malignancy, participants were divided into a malignancy group (n=385) and a control group (n=30 070). Propensity score matching (PSM) was performed at a ratio of 1∶4 using age, gravidity, parity, chronic hypertension, pregestational diabetes mellitus, pre-pregnancy body mass index(BMI) ≥ 28 kg/m², and history of assisted reproductive technology as covariates. The malignancy group was further stratified by the timing of cancer diagnosis into a pre-pregnancy subgroup (n=367, malignancy diagnosed before pregnancy) and a pregnancy-associated subgroup (n=18, malignancy diagnosed during pregnancy or the puerperium). The clinical characteristics and maternal–fetal outcomes were retrospectively analyzed for all groups. This study was approved by the Medical Ethics Committee of Drum Tower Hospital, the Affiliated of Hospital Nanjing University Medical School (Approval No. 2025-0873-01). As this was a retrospective single-center cohort study, the requirement for informed consent was waived.

①The incidence of pregnancy complicated by malignancy was 1.26% (385/30 455) and showed a significant increasing trend over the study period (χ²_trend=33.61, P<0.001), with thyroid cancer being the most common type (77.9%, 300/385). After propensity score matching, 384 women were included in the malignancy group and 1 533 in the control group. ②Compared with the control group, women in the malignancy group had a significantly lower gestational age at delivery and a lower incidence of premature rupture of membranes (PROM), but significantly higher rates of intensive care unit (ICU) admission and postpartum blood transfusion (P<0.05); no significant differences were observed in other maternal or neonatal outcomes (P>0.05). ③Within the malignancy group, women diagnosed during pregnancy had a lower gestational age at delivery, higher proportions of pre-delivery hemoglobin levels <110 g/L, higher ICU admission and transfusion rates, and lower neonatal birth weight than those diagnosed before pregnancy (P<0.001). ④Among the 18 women diagnosed with malignancy during pregnancy, six received chemotherapy or surgical treatment during pregnancy, one maternal death occurred, and all neonates survived.

The incidence of pregnancy complicated by malignancy has shown an increasing trend over recent years. Women who were diagnosed before pregnancy and conceived after completing standard treatment with stable disease generally had favorable maternal and neonatal outcomes, whereas those diagnosed during pregnancy tended to have poorer outcomes. Early identification and multidisciplinary standardized management are therefore essential for improving maternal and neonatal prognosis in women with pregnancy complicated by malignancy.

To explore the influencing factors of postoperative infection in patients with gynecological malignant tumors.

A total of 234 patients with gynecological malignancies who underwent surgical treatment at the Department of Gynecology, Chongqing General Hospital, Chongqing University from April 2020 to March 2023 were selected as the study subjects. Among them, 80 cases were cervical cancer, 107 cases were ovarian cancer, and 47 cases were endometrial cancer. Patients were divided into infection group (n=55) and non-infection group (n=179) based on whether they developed postoperative infection. A retrospective analysis was conducted to collect general clinical data and preoperative, surgical, and postoperative data from both groups, and comparative analyses were performed using independent-samples t test and chi-square test. Multivariate unconditional logistic regression analysis was used to analyze the independent influencing factors of postoperative infection in gynecological malignant tumor patients. There were no statistically significant differences in age, body mass index (BMI), or other general clinical data between two groups (P>0.05). The procedures followed in this study were approved by the Medical Ethics Committee of Chongqing General Hospital, Chongqing University (Approval No. KYS2022-012-01).

①Among 234 patients with gynecological malignancies, 55 cases (23.5%) developed postoperative infections. Of the 55 infected patients, 60 strains of pathogens were cultured, with Escherichia coli having the highest incidence (32/55, 58.2%), followed by Pseudomonas aeruginosa (5/55, 9.1%), Enterobacter cloacae subsp. cloacae (4/55, 7.3%), and Klebsiella pneumoniae (4/55, 7.3%); 8 cases (14.5%) had dual bacterial infections. ②Univariate analysis revealed that there were statistically significant differences between two groups in 13 factors, including tumor type, American Society of Anesthesiologists (ASA) classification, operation duration, type of vaginal stump suture, use of drainage tube, drainage tube placement location, duration of indwelling drainage tube, number of urinary catheter insertions, duration of indwelling urinary catheter, ≥1 central venous catheterization, duration of central venous catheterization, types of postoperative use of antibiotics, and duration of antibiotic use (P<0.05). ③Multivariate unconditional logistic regression analysis showed that ASA classification Ⅲ+ Ⅳ and conventional suture for vaginal stump closure were independent risk factors for postoperative infection in patients with gynecological tumors (OR=3.266, 3.632, 95%CI: 1.361-7.645, 1.454-9.072, P=0.008, 0.006). Compared to postoperative cephalosporin antibiotics alone, postoperative use of non-cephalosporin antibiotics was an independent protective factor against postoperative infection in patients with gynecological malignancies (OR=0.298, 95%CI: 0.127-0.702, P=0.006). Compared to postoperative antibiotic use for 1-3 days, postoperative antibiotic use for 4-7 days and ≥8 days were also independent protective factors against postoperative infection in patients with gynecological malignancies (OR=0.103, 0.073, 95%CI: 0.031-0.340, 0.019-0.277, both P<0.001).

ASA classification, vaginal suture type, type of postoperative antibiotics used, and duration of postoperative antibiotic use are all independent influencing factors for postoperative infection in patients with gynecological malignancies. Postoperative nutritional intervention, intraoperative antimicrobial suture utilization, proper postoperative use of antibiotics and standardized postoperative antibiotic protocols may effectively reduce the risk of postoperative infection in patients with gynecological malignancies.

Chinese Expert Consensus on Standardized Surgical Treatment for Ovarian Cancer in Elderly Patients (2024 Edition)(here after referred to as "the Consensus") advocates for optimized surgical decision-making by assessing patients′ functional status and tumor resectability. It emphasizes preoperative management of frailty and comorbidities, intraoperative optimization of anesthesia strategies and surgical collaboration, and postoperative implementation of enhanced recovery after surgery (ERAS) protocols, nutritional support, and complication prevention measures to reduce perioperative risks. The Consensus defines elderly ovarian cancer patients as those aged ≥65 years. By integrating evidence-based recommendations with practical guidance, the Consensus establishes a scientific framework for the standardized management of elderly ovarian cancer patients, offering critical insights to guide therapeutic practices. This article provides a comprehensive interpretation of the Consensus, aiming to promote standardized surgical treatment for elderly patients with ovarian cancer.

Hyperandrogenism (HA) is a pathological condition in which circulating androgen levels are abnormally elevated in women. It commonly presents with acne, hirsutism, oligomenorrhea, or amenorrhea, and may impair reproductive capacity. In June 2025, Society for Endocrinology released the latest Clinical Practice Guideline for the Evaluation of Androgen Excess in Women (hereafter referred to as " the Guideline" ), providing evidence-based recommendations for the evaluation and management of HA in women. The Guideline was initiated by integrating professional knowledge from endocrinology, obstetrics and gynecology, clinical biochemistry, and nursing, offering clinicians a unique perspective on patients with HA. The Guideline based on evidence-based medicine, provides multiple disciplinary team (MDT) diagnostic and therapeutic guidance for the clinical assessment, hormone testing, gonadotropin-releasing hormone (GnRH) suppression test, 96-hour dexamethasone suppression test (DST) and imaging examinations in women with HA. Based on the Guideline, the authors intend to focus on the androgen metabolic pathways and regulatory mechanisms in women, the disease spectrum and clinical features of women with HA, as well as the differential diagnosis from other diseases and the clinical evaluation system: interpreting the entire process from medical history to imaging examinations in women with HA, with the aim of providing a reference for the standardized diagnosis and treatment of women with HA in clinical practice.

Hereditary pediatric rare diseases are a class of diseases characterized by low incidence rates but diverse disease types, complex pathogenesis, severe disease conditions, rapid progression, and high disability and mortality rates among affected patients. Children are the primary population affected by hereditary rare diseases, with over 50% of such diseases manifesting during childhood. With the continuous improvement of healthcare standards, the prevention, screening, and diagnosis of rare diseases have become significant challenges in the global medical field in recent years. This paper elucidates the latest research advances in diagnostic technologies related to hereditary pediatric rare diseases, as well as new directions in the screening, prevention, and treatment of these diseases, and the construction of minimal data set (MDS), so as to enhance the understanding of such diseases among clinical physicians and researchers and to provide references for promoting precision medicine.

Peripheral perfusion index (PPI) is a new generation of measurement parameter reflecting peripheral tissue perfusion. PPI can continuously and in real time reflect peripheral tissue perfusion in neonates, offering advantages such as being non-invasive, sensitive, accurate, and convenient. In recent years, the application of PPI as a tool for evaluating hemodynamic status has become increasingly widespread in neonatology. In clinical practice, PPI is primarily used for screening neonatal congenital heart disease (CHD), early diagnosis of patent ductus arteriosus (PDA) in preterm infants, early prediction of neonatal diseases, assessment of neonatal disease severity, and prediction of adverse outcomes in neonates. Additionally, PPI can be applied to guide the treatment of neonatal shock, evaluate the therapeutic efficacy of neonatal anemia, and instruct ventilator weaning for critically ill neonates. The author intends to elaborate on the latest research status regarding the concept and measurement principle of PPI, the normal reference values of PPI in neonates and its influencing factors, and clinical application of PPI in neonatology.

To analyze the clinical features of Chlamydia pneumoniae pneumonia in children (CPP).

A total of 174 children with CPP admitted to the Suzhou University Affiliated Children′s Hospital from July 2023 to April 2025 were selected as research subjects. Based on the type of infection, they were divided into two groups, group A (n=96) and group B (n=78). The group B was further categorized into three subgroups according to the types of pathogens: subgroup B1 (n=40, mixed viral/mycoplasma pneumoniae infections), subgroup B2 (n=25, mixed bacterial infections), and subgroup B3 (n=13, mixed viral/mycoplasma pneumoniae and bacterial infections). The clinical manifestations, laboratory test results, and imaging characteristics were compared retrospectively. The study followed the standards set by the Medical Ethics Committee of the Suzhou University Affiliated Children′s Hospital and got the committee′s approval (Approval No. 2025CS134), and informed consent from the children′s guardians were obtained.

①Among 174 children with CPP, 96 cases (55.2%) had isolated CP infection, while 78 cases (44.8%) had mixed infections; the majority were male (64.9%, 113/174) and over 6 years old (90.8%, 158/174), averaging 14 days of illness. All children had cough symptoms, 76 cases (43.7%) had fever, and 138 cases (79.3%) had sputum production. Among children with mixed infections, rhinovirus (HRV) had the highest detection rate (27/78, 34.6%), followed by Staphylococcus aureus (12/78, 15.4%). ②The incidence of wheezing in group A was significantly lower than that in subgroup B1, with the difference reaching statistical significance (P<0.05). In group A, the incidence of moderate fever was significantly higher, whereas the incidence of high fever was significantly lower than that in subgroup B2, and both differences were statistically significant (P<0.05). In addition, the incidence of vomiting in group A was significantly lower than that in subgroup B3, and the difference was also statistically significant (P<0.05). ③Comparisons of white blood cell count (WBC), neutrophil percentage (NEUT%), hs-CRP, alpha-hydroxybutyrate dehydrogenase(α-HBDH), alanine aminotransferase (ALT), and creatine kinase-MB isoenzyme (CK-MB) levels between group A and groups B1, B2, and B3 showed no significant differences (P>0.05). ④Imaging examination results showed that unilateral lung involvement was more common (71.8%, 125/174), with the right lower lobe being the most commonly affected area (19.5%, 34/174), and lesions involving ≥2 lung lobes were observed in 74 cases (42.5%).

The incidence of mixed infections in children with CPP is high. The younger they are, the more likely they are to have mixed infections, which come with more severe symptoms. For children with CPP, we should actively test for pathogens to quickly identify mixed infections and offer targeted treatments.

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and adolescents. Its core symptoms, including inattention, hyperactivity, and impulsivity, may persist into adulthood and significantly affect academic performance, family functioning, social relationships, daily living skills, and overall quality of life. Currently, the diagnosis of ADHD mainly relies on clinical assessment because no definitive biological markers have been established. Therefore, reliable and valid instruments for evaluating functional impairment have become increasingly important in ADHD assessment and management. Functional impairment assessment tools can systematically evaluate difficulties experienced by children with ADHD in real-world settings and provide valuable information for screening, diagnostic evaluation, treatment planning, and outcome monitoring. However, most existing ADHD rating scales primarily focus on symptom severity, whereas relatively few instruments comprehensively assess functional impairment across multiple domains. This review summarizes the current research status, clinical applications, and future development trends of functional impairment assessment instruments for children and adolescents with ADHD. Four representative scales, including the ADHD functional impairment scale (ADHD-FX), Barkley functional impairment scale (BFIS), impairment rating scale (IRS), and Weiss functional impairment rating scale (WFIRS), are systematically reviewed. Their psychometric properties, target populations, strengths, limitations, and clinical utility are discussed, with particular emphasis on their roles in diagnostic evaluation, treatment goal setting, and therapeutic outcome assessment. This review aims to provide theoretical evidence and practical guidance for improving the clinical assessment framework of ADHD and promoting the development of individualized intervention strategies.

To explore the improvement effect of " medical-education-rehabilitation-childcare" service management model on the self-care and social adaptation abilities of children with intellectual disabilities and the quality of life (QoL) of their parents.

A total of 80 children with intellectual disabilities admitted to Pingshan County " Qingmiao Rescue" Rehabilitation and Care Center for Disabled Children and the Department of Rehabilitation Medicine, People′s Hospital of Pingshan County from June 2022 to December 2024 were included as study subjects by quota sampling method. They were divided into study group (n=40, who received intervention using " medical-education-rehabilitation-childcare" service management model) and control group (n=40, who received intervention using a combination of routine comprehensive rehabilitation training and family rehabilitation training) by random number table method. Before and after intervention, the Barthel index scale was used to assess the activity of daily living (ADL) of the two groups of children with intellectual disabilities, the social maturity scale was used to assess their social adaptability, and the World Health Organization quality of life scale-brief (WHOQOL-BREF) was used to assess the QoL of the children′s parents. Statistical comparisons were performed using independent or paired samples t test, Mann-Whitney U test, or Wilcoxon signed-rank test. The procedures followed in this study complied with the regulations of the Ethics Committee of People′s Hospital of Pingshan County and were approved by the ethics committee (Approval No. 20244142).

①There were no significant differences in gender, age, intelligence quotient (IQ), and degree of intellectual disability between the two groups of children with intellectual disabilities (all P>0.05). ②Before intervention, there were no differences in each dimension score and total score of ADL ability, S-M, as well as the total QoL scores of the parents of two groups of children (all P>0.05). After intervention, the total score of ADL ability in study group was (70.5±13.3) points, which was significantly higher than (62.3±16.2) points in control group (t=-3.04, P=0.002). Meanwhile, after intervention, both the total score and each dimension score of ADL ability and S-M in study group of children were significantly improved compared to before intervention within the group (all P<0.05). After intervention, the total S-M score and scores for interpersonal communication, participation in group activities, and self-management ability in the study group were significantly higher than those in control group (P=0.035, 0.007, 0.005, 0.001). After the intervention, the total QoL score of the parents of children in study group was (72.4±9.9) points, which was significantly higher than that of control group (58.0±10.2) points, and the difference was statistically significant (t=-7.58, P<0.001). After intervention, the total QoL scores of the parents of children in both the study group and the control group were significantly higher than those before the intervention within each group, and the differences were statistically significant (P<0.05).

Compared with the conventional comprehensive rehabilitation training and family rehabilitation training model, the " medical-education-rehabilitation-childcare" service management model has greater advantages and can significantly improve the self-care ability, social adaptation behavior of children with intellectual disabilities and the QoL of their parents.

To explore the diagnostic value of multimodal functional magnetic resonance imaging (fMRI) indicators combined with clinical features for delayed brain function development in children.

A total of 241 children with delayed brain function development admitted to the Children′s Hospital of Soochow University from January 2022 to December 2024 were retrospectively selected as the study group. Another 200 healthy children who underwent physical examination during the same period in the same hospital were selected as the control group. All the children underwent multimodal fMRI to obtain the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in the subcortical white matter of the frontal, parietal, and occipital lobes (SWM-FPOL), as well as the ratios of N-acetylaspartate (NAA) to creatine (Cr) (NAA/Cr) and glutamate/glutamine complex (Glx) to Cr (Glx/Cr). Clinical data of all subjects were collected retrospectively. Univariate and multivariate analyses were performed using independent-samples t test, chi-square test, and multivariate unconditional logistic regression to identify influencing factors (multimodal fMRI indicators and clinical features) of delayed brain function development in children. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of multivariate unconditional logistic regression results based on multimodal fMRI indicators combined with clinical features for delayed brain function development in children. There were no statistically significant differences in general clinical data such as age and gender ratio between two groups (P>0.05). This study was approved by the Ethics Committee of the Children′s Hospital of Soochow University (Approval No. 2025cs129).

①The proportion of neonatal asphyxia, maternal complications during pregnancy and perinatal period, premature birth, infant diseases, parental mental retardation, ADC values and Glx/sCr of SWM-FPOL in study group were higher than those in control group, while the parents′ education level, birth weight, and FA values and NAA/Cr level of SWM-FPOL were significantly lower than those in control group, and all the differences were statistically significant (P<0.05). ②Multivariate unconditional logistic regression analysis showed that maternal complications during pregnancy and perinatal period (OR=2.635, 95%CI: 1.388-5.002), preterm birth (OR=3.047, 95%CI: 1.712-5.422), parental mental retardation (OR=4.533, 95%CI: 2.323-8.844), high ADC value of SWM-FPOL (OR=3.642, 95%CI: 2.253-5.887), high Glx/Cr of SWM-FPOL (OR=6.487, 95%CI: 3.430-12.265) were independent risk factors for delayed brain function development in children, while high NAA/Cr of SWM-FPOL (OR=0.152, 95%CI: 0.084-0.275) was its independent protective factor (P<0.05). ③The ROC curve analysis results showed that the area under the curve (AUC) of maternal complications during pregnancy and perinatal period, preterm birth, parental mental retardation, and ADC value, NAA/Cr, Glx/Cr of SWM-FPOL alone and these six indicators combined diagnoses of delayed brain function development in children were 0.617, 0.636, 0.616, 0.731, 0.803, 0.787 and 0.919 respectively (all P<0.05).

The combination of clinical features of child such as maternal complications during pregnancy and perinatal period, preterm birth, and parental mental retardation with fMRI indicators of child (ADC value, Glx/Cr, and NAA/Cr of SWM-FPOL) has a relatively high value in the diagnosis of delayed brain function development in children.

In recent years, against the backdrop of widespread administration of acellular pertussis (aP) vaccines, the incidence of pertussis has exhibited a resurgent trend in numerous countries across the globe. Molecular epidemiological studies have revealed that population-level variations have occurred in multiple virulence genes encoding vaccine-associated antigens of Bordetella pertussis (Bp), accompanied by the replacement of dominant clonal lineages, which may be implicated in the phenomenon of "pertussis resurgence". This review summarizes the variation characteristics of major vaccine-associated antigen genes of Bp in recent years, including pertussis toxin promoter (ptxP), pertussis toxin subunit A (ptxA), pertactin gene (prn), filamentous hemagglutinin gene (fhaB), and fimbriae gene (fim), with a focus on the analysis of their evolutionary trends in circulating strains in China and the discrepancies from the antigen components of currently used co-purified acellular pertussis vaccines (cp-ACVs). Available evidence demonstrates that vaccine immune pressure may drive the expansion of non-vaccine-type alleles such as prn deficiency, ptxP3, and ptxA1, while antimicrobial selective pressure facilitates the formation of dominant clonal clusters harboring multiple phenotypic characteristics. The aforementioned structural alterations of antigens may elevate the potential risks of vaccine antigen mismatch and immune escape. Accordingly, sustainable implementation of whole-genome sequencing-based molecular epidemiological surveillance, combined with optimization of vaccine antigen design by integrating host immune response mechanisms, constitutes a crucial strategy to counteract the continuous evolution of Bp and enhance the efficacy of pertussis prevention and control.

To investigate the early growth and development pattern of small for gestational age (SGA) infants born to mothers with gestational diabetes mellitus (GDM).

A total of 358 pregnant women and their live singleton SGA infants delivered at Wuhan Children′s Hospital from 2012 to 2014 were selected for this study. Based on whether the mothers were diagnosed with GDM before 32 weeks of gestation, the subjects were divided into GDM group (n=44, GDM mothers and their SGA infants) and non-GDM group (n=314, mothers without GDM and their SGA infants). A prospective, birth cohort study was designed, the regular follow-ups were conducted on SGA infants of two groups and to monitor their physical development indicators. The weight for age Z-score (WAZ) and length for age Z-score (LAZ) at age of 0 (birth), 6, 12, 18, and 24 months of SGA infants, as well as the velocity of weight increments Z-score (V-WIZ) and length of increments Z-score (V-LIZ) every 6 months after birth (defined in this study as age brackets 1, 2, 3, and 4, corresponding to 0-6 months, 6-12 months, 12-18 months, and 18-24 months of age, respectively) of SGA infants, were compared between two groups and stratified by gender by Mann-Whitney U test. This study was approved by the Medical Ethics Committee of Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology (Approval No. 2010R009-F04). Informed consent forms was obtained from all participating pregnant women.

① The gestational age at delivery of pregnant women in GDM group was lower, and the incidence of hypertensive disorders of pregnancy (HDP) was higher than those in non-GDM group, and the differences were statistically significant (P<0.05). ② The V-LIZ for SGA infants at age bracket 1 in GDM group was 0.31 (-0.36, 0.92), which was lower than that of 0.80 (0.08, 1.53) in non-GDM group; meanwhile, the V-WIZ and V-LIZ for female SGA infants at age bracket 1 in GDM group were 0.90 (0.25, 1.94) and 0.01 (-0.61, 0.92), respectively, which were higher and lower than those of 0.63 (-0.18, 1.34) and 0.92 (0.01, 1.53), respectively in non-GDM group, and above differences were statistically significant (Z=-2.28, -2.27, -2.69; P=0.022, 0.028, 0.007). ③ A comparison of WAZ and LAZ curves for SGA infants in GDM group at various months of age (0, 6, 12, 18, 24 months) showed that WAZ increased rapidly before 6 months of age and LAZ increased rapidly before 12 months of age for both male and female SGA infants. Furthermore, the LAZ curve of aged 0-6 months for female SGA infants was flatter compared to male SGA infants. ④ There were no significant differences between male and female SGA infants in GDM group in V-WIZ and V-LIZ of the four age brackets, respectively (P>0.05).

The early growth patterns of SGA infants born to GDM mothers are different from those in the non-GDM group. There is a significant gender difference, which is that female SGA infants present a pattern of faster weight gain but lagging length growth before 6 months of age.

As women of childbearing age postpone childbearing, ovarian dysfunction and resulting subfertility are becoming increasingly pronounced. Premature ovarian insufficiency (POI) is a devastating blow to women of childbearing age who have reproductive needs. As a reproductive organ, the ovary has a relatively limited reproductive lifespan, and the decline in ovarian function is generally irreversible. Once ovarian dysfunction occurs, the number of remaining follicles in the ovaries gradually depletes within a few years. Therefore, early diagnosis of POI is crucial. The causes of POI in women of childbearing age are complex and diverse, and the pathogenesis remains unclear. Although women with POI still have an approximately 5% chance of spontaneous pregnancy, traditional assisted reproductive technologies currently cannot meet the reproductive needs of POI patients. Oocyte donation remains the most effective fertility treatment option for these patients. Advances in ovarian stimulation, in vitro activation (IVA), mitochondrial replacement therapy (MRT), stem cell therapy (SCT), platelet-rich plasma (PRP) therapy, as well as immunotherapy and other treatments, are offering more options for POI patients. However, most of these technologies are still in the basic research stage, and the risks of future clinical application remain unclear. The author intends to explain the latest research status on the causes of POI patients and the fertility treatment options that POI patients may choose, aiming to explore the advantages and limitations of various treatment options, and provide a reference for developing fertility plans for patients with POI.

Pulmonary complications subsequent to hematopoietic stem cell transplantation (HSCT) constitute a significant factor contributing to transplant-related morbidity and mortality among pediatric patients. Therefore, the early and accurate identification of pulmonary abnormalities is of paramount importance for improving prognosis of these post-HSCT children. As a non-invasive assessment tool, pulmonary function test (PFT) plays a pivotal role in monitoring pulmonary health, providing early warning for long-term complications such as pulmonary graft-versus-host disease (GVHD), and evaluating therapeutic responses in HSCT recipients. However, compared to the adult population, research on the longitudinal trajectory of pulmonary function in post-HSCT children is relatively limited, and the existing findings are inconsistent. Furthermore, the limitations of traditional PFT, the high demand for patient cooperation, have become increasingly apparent, which has spurred researchers to explore novel auxiliary diagnostic techniques including multiple-breath washout (MBW) test, forced oscillation technique, and parametric response mapping (PRM), to achieve more sensitive detection of early-stage lung injury. This review aims to systematically summarize the characteristics of pulmonary function changes in post-HSCT children, discuss the clinical utility and challenges of PFT in monitoring, and introduce recent advances in novel assessment methodologies, so as to provide a reference for clinicians to optimize pulmonary complications management strategies for pediatric HSCT recipients.

To explore the clinical manifestations, complications, diagnosis, treatment and prognosis in neonatal Ureaplasma parvum (Up) meningitis.

A preterm infant with early-onset Up meningitis (infant 1), who was admitted to Xuzhou Central Hospital on October 31, 2023 was included into this study. A retrospective analysis was conducted on the clinical data of infant 1, including medical history, physical examination findings at admission, relevant auxiliary examination results, and the diagnosis and treatment process. Using the search terms " Ureaplasma parvum" " meningitis" " neonate/newborn" " preterm/premature" both in Chinese and English, literature related to neonatal Up meningitis indexed in domestic databases (Wanfang Data Knowledge Service Platform, CNKI, and VIP Database) and international databases (PubMed, Embase, and Web of Science) from the inception of each database to April 2025 was searched. A comprehensive analysis of the clinical manifestations, complications, diagnosis, treatment, and prognosis of Up meningitis in newborns was conducted on the related literature. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

①Infant 1: a female preterm infant with early-onset Up meningitis born at a gestational age of 34^{+ 1} weeks, was admitted to our hospital on the day of birth due to " moaning and frothing for 30 minutes" after delivery. Antenatal vaginal swab from the mother and a postnatal nasal swab from the infant 1 both tested positive for Ureaplasma Urealyticum (UU) nucleic acid. On day 6 after admission, the infant 1 began to experience recurrent low-grade fevers accompanied by apnea. Combined with a cerebrospinal fluid white blood cell count (WBC) of 62×10⁶/L, a glucose concentration of 0.55 mmol/L, and a protein level of 1.29 g/L, metagenomic next-generation sequencing (mNGS) detected Up in the cerebrospinal fluid, with a sequence count of 154 and a relative abundance of 32.25%, Up meningitis was diagnosed. On day 7 after admission, high-dose intravenous azithromycin was initiated at 20 mg/(kg·d) once daily. The dose was reduced to 5 mg/(kg·d) once daily on day 10 after admission. From day 18 to 27 after admission, due to " intraventricular hemorrhage and severe obstructive supratentorial hydrocephalus", daily therapeutic cerebrospinal fluid aspiration (10 mL/kg) was performed. The cerebrospinal fluid parameters gradually normalized, and azithromycin was discontinued on day 27 after admission. However, the hydrocephalus did not significantly improve. On day 29 after admission, the infant 1 was transferred to another hospital for Ommaya reservoir placement. From 3 to 6 months after birth, there was no longer any need to withdraw hydrocephalus fluid, and the symptoms of hydrocephalus improved. At a corrected age of 6 months, the development of infant 1 was assessed as essentially normal. ②Literature review results: A literature search identified 15 relevant articles on neonatal Up meningitis, reporting on 16 affected neonates (infants 2-17). Including infant 1, a total of 17 neonates with Up meningitis were analyzed. Among these 17 cases, excluding one case whose gender was not reported, there were 6 males and 10 females; gestational age was not reported in one case, but the median gestational age of the remaining 16 cases was 31.5 weeks (27.3, 39.8 weeks), with 10 cases being preterm (gestational age at birth < 37 weeks); birth weight was not reported in one case, but the median birth weight of the remaining 16 cases was 1 860 g (997, 3 355 g), with 9 cases having low birth weight (birth weight < 2 500 g); the median age at onset was 7 days after birth (3.0, 10.5 days), and 9 cases were classified as early-onset (within 7 days after birth) Up meningitis. Clinically, 12 cases presented with fever, 6 with neurological abnormalities, and 4 with respiratory abnormalities. Complications included hydrocephalus in 10 cases and intracranial hemorrhage in 3 cases. The cerebrospinal fluid examination results showed an elevated WBC count (median: 608×10⁶/L), a significantly increased protein level (3.7±2.0) g/L, and a significantly decreased glucose concentration (median: 0.5 mmol/L). In 10 cases, mNGS was the sole method used to detect Up in the cerebrospinal fluid. Commonly used antibiotics for Up meningitis included erythromycin, azithromycin [often at a dose of 20 mg/(kg·d)], and quinolones, with treatment courses ranging from 3 to 10 weeks. Hydrocephalus was managed with Ommaya reservoir insertion alone in 4 cases. Regarding outcomes, follow-up information was unavailable for one infant. Of the remaining 16 cases, follow-up assessments indicated normal intellectual and motor development in 14 infants.

Neonatal Up meningitis predominantly occurs in preterm infants, with early-onset cases being the most common. The primary clinical manifestation is fever, while the incidence of neurological abnormalities is relatively low. Some infants may present with respiratory abnormalities, and the condition is frequently associated with complications such as hydrocephalus and intracranial hemorrhage. Cerebrospinal fluid analysis typically reveals an elevated WBC count, significantly increased protein levels, and markedly decreased glucose concentrations. mNGS is commonly used for the detection of Up. Macrolides and quinolones are the antibiotics of choice for treatment, while Ommaya reservoir implantation alone is the preferred approach for managing hydrocephalus. The prognosis is favorable for the vast majority of infants following treatment.

National policy of China has prioritized prevention and control of birth defects and congenital disabilities. Prenatal diagnosis, as a key component of the three-tier prevention system, plays a critical and strategically important role in carrying out measures for healthy childbirth and child-rearing. With the clinical application of chromosomal microarray analysis (CMA) and genome sequencing (GS) technologies, the field of prenatal diagnosis is undergoing significant advancements. GS technology is now transforming clinical practice and advancing the field toward precision medicine. However, as GS technology becomes rapidly popularized in prenatal applications, the demand for standardizing its application continues to rise. The authors aim to systematically review the development of prenatal diagnostic technologies, with a focus on the indications for GS in prenatal diagnosis, evidence from its clinical applications, and leading international practices, and to further explore future trends in the integration of multiple GS technologies. The goal is to develop an optimized strategy for deeply integrating GS technologies into prenatal diagnosis, provide a theoretical basis and practical reference for improving the standardization and precision of prenatal diagnosis in China, and simultaneously offer robust technical support for strengthening the prevention and control of birth defects.

To explore the therapeutic effects of surgical treatment for patients with refractory postpartum hemorrhage (IPPH) after cesarean sections.

Clinical research literature on the efficacy of surgical treatment for patients with IPPH after cesarean section was selected from databases including China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Chinese Journal Service Platform, China Biomedical Literature Database, PubMed, Embase, and Web of Science using computer-based retrieval. Key words in both Chinese and English, such as ＂cesarean section＂ ＂refractory postpartum hemorrhage＂ etc., were employed to screen clinical studies that met the inclusion and exclusion criteria of this research and had acceptable literature quality. The retrieval time frame was from January 1, 2000, to June 1, 2024. RevMan 5.3 software was used to analyze the obtained data. First, the Cochrane-Q test was applied to detect the heterogeneity among the included literature, and a random effects model or a fixed effects model was used for Meta-analysis based on the results. For the efficacy evaluation index postpartum hemorrhage(PPH) volume adopted in this study, the standardized mean difference (SMD) was used as the effect size, and its 95%CI was calculated. A funnel plot was used to evaluate the publication bias of the included literature.

According to the literature retrieval strategy set in this study, a total of 17 pieces of literature on the efficacy of surgical treatment for patients with IPPH after cesarean section were included, all of which were of grade B quality. There was significant heterogeneity among the literature. The studies involved 775 patients with IPPH after cesarean section treated surgically, and a total of eight surgical treatment methods were adopted. The SMD with PPH volume as the efficacy index for 8 methods were as follows, respectively. The SMD for the efficacy of modified B-Lynch suture combined with bilateral ascending uterine artery ligation was -2.07 (95%CI: -3.14--1.00, P<0.001); the SMD for the efficacy of modified B-Lynch suture was -0.59 (95%CI: -0.84--0.34, P<0.001); the SMD for the efficacy of bilateral ascending uterine artery ligation was -2.77 (95%CI: -4.91--0.64, P<0.001); the SMD for the efficacy of uterine artery ligation combined with intrauterine water balloon compression was -1.27 (95%CI: -1.76--0.77, P<0.001); the SMD for the efficacy of uterine artery ligation combined with Hayman suture was -5.24 (95%CI: -6.01--4.48, P<0.001); the SMD for the efficacy of Bakri balloon intrauterine packing was -3.71 (95%CI: -4.77--2.65, P<0.001); the SMD for the efficacy of pelvic vascular interventional embolization was -1.63 (95%CI: -1.92--1.34, P<0.001); and the SMD for the efficacy of uterine cross-ligature was -4.52 (95%CI: -11.26--2.22, P=0.190). The pooled effect size for the efficacy of the eight surgical treatment methods, that is, the overall SMD for efficacy was -2.46 (95%CI: -3.09--1.82, P<0.001). The efficacy of the study group (use one of the eight methods) was superior to that of the control group, and the differences were all statistically significant (P<0.05).

The existing eight surgical treatment methods, such as modified B-Lynch suture etc., have definite clinical efficacy in treating patients with IPPH after cesarean section and can be selected for individual or combined application according to the actual conditions of patients.

To investigate the value of transvaginal color Doppler ultrasound combined with E-cervix elastography parameters in predicting the mode of delivery of pregnant women in the third trimester.

A total of 300 pregnant women who underwent late-pregnancy ultrasound examination at Xi′an Daxing Hospital from January 2022 to December 2024 were retrospectively enrolled. According to the mode of delivery, they were divided into a vaginal delivery group (n=201) and a cesarean delivery group (n=99). Cervical parameters including cervical length (CL), uterocervical angle (UCA), elasticity contrast index (ECI), hardness ratio, internal os strain (IOS), external os strain (EOS), and IOS/EOS were analyzed. Multivariate unconditional logistic regression analysis was performed to identify factors associated with the mode of delivery. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of individual parameters and the combined model. This study was approved by the Medical Ethics Committee of Xi′an Daxing Hospital (Approval No. KY2024-002).

① Compared with the cesarean delivery group, the vaginal delivery group showed significantly lower CL and hardness ratio, and significantly higher UCA, ECI, IOS, and EOS (all P<0.05). ② Multivariate logistic regression analysis demonstrated that CL (OR=4.408, 95%CI: 2.486-7.817, P<0.001) and hardness ratio (OR=1.024, 95%CI: 1.005-1.043, P=0.012) were independent risk factors for cesarean delivery of pregnant women in the third trimester, whereas UCA (OR=0.934, 95%CI: 0.911-0.957, P<0.001) was an independent protective factor. ③ROC curve analysis showed that the area under the curve (AUC) for predicting vaginal delivery was 0.750 for UCA, 0.706 for CL, 0.652 for hardness ratio, 0.617 for IOS, 0.602 for EOS, and 0.596 for ECI. The combined model (UCA, CL, hardness ratio, IOS, EOS, and ECI) achieved an AUC of 0.841 (95%CI: 0.792-0.890), with a sensitivity of 86.1% and a specificity of 73.7%.

Transvaginal color Doppler ultrasound combined with E-cervix elastography can comprehensively evaluate cervical maturity from both anatomical and biomechanical perspectives. A multiparametric combined model demonstrates superior predictive performance compared with single parameters and may provide an objective basis for individualized assessment of delivery mode of pregnant women in the third trimester.

To explore the effects of the double-lumen water balloon combined with oxytocin on cervical ripening and impact on pregnancy outcomes in term pregnant women with borderline oligohydramnios.

A total of 88 term borderline oligohydramnios pregnant women who delivered at the Chaohu Hospital Affiliated to Anhui Medical University between March 2021 and March 2024 were selected as the study subjects. They were randomly divided using a random number table method into study group (n=44, inducing labor with double-lumen water balloon combined with oxytocin) and control group (n=44, inducing labor with oxytocin). The cervical ripeness before and after induced labor, induction outcomes, neonatal outcomes, and adverse pregnancy outcomes were compared between two groups using the independent-samples t test or chi-square test, as appropriate. This study was approved by the Medical Ethics Committee of Chaohu Hospital Affiliated to Anhui Medical University (Approval No. KYXM202103-053). There were no significant differences in baseline characteristics, including maternal age, gestational age, and gravidity between the two groups (P> 0.05).

①After labor induction, the scores of cervical position, cervical consistency, cervical dilation, cervical effacement, and fetal station and the total Bishop score were all significantly better in the study group than those in control group (t=11.58, 9.51, 11.03, 11.07, 9.98, 6.24; all P<0.001). The proportion of vaginal delivery in study group was 93.2% (41/44), which was significantly higher than that in control group (77.3%, 34/44) (χ²=5.57, P=0.018). The induction bleeding volume and postpartum blood loss in study group were significantly lower than those in control group, and the durations of the first and third stages of labor were significantly shorter in the study group (t=2.37, P=0.020; t=2.85, P=0.005; t=3.23, P=0.002; t=8.80, P<0.001). ②There were no significant differences between two groups in neonatal birth weight and Apgar score at 5 min after delivery (P>0.05). ③The overall incidence of adverse pregnancy outcomes was significantly lower in study group than that in control group [2.3% (1/44) vs 13.6% (6/44), χ²=3.88, P=0.049].

The combination of a double-lumen water balloon with oxytocin has certain value in promoting cervical ripening and increasing vaginal delivery rates in full-term pregnant women with borderline oligohydramnios.