To investigate the clinical efficacy of CO₂ laser in the treatment of cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VaIN).

A retrospective analysis was conducted on 607 patients with CIN and (or) VaIN, who were hospitalized at International Peace Maternity and Child Health Hospital, Affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to December 2016. Independent-samples t test was used for statistical analysis of age between different patients. Chi-square test was used to compare the composition ratio of different CO₂ laser positions, the composition ratio of different CO₂ laser times and the history of loop electrosurgical excision procedure (LEEP). Multivariate unconditional logistic regression analysis was used to analyze influencing factors of human papillomavirus (HPV) negative rate and pathological degradation after CO₂ laser treatment. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

① The total effective rate of CO₂ laser treatment was 95.4% (579/607), and the disease recurrence rate was 4.6% (28/607). Among them, the effective rates of CO₂ laser treatment for CIN, VaIN and CIN with VaIN were 95.3% (430/451), 98.1% (102/104) and 90.4% (47/52), respectively. ② After CO₂ laser treatment, the negative rate of HPV was 74.1% (450/607). The negative rates of HPV in CIN, VaIN and CIN with VaIN were 80.0% (361/451), 54.8% (57/104) and 61.5% (32/52), respectively. ③ Multiple unconditional logistic regression analysis showed that the history of LEEP (OR=0.500, 95%CI: 0.273-0.915, P=0.025) was an independent protective factor for HPV turning negative 2 years after CIN and/or VaIN patients received CO₂ laser treatment. ④ After CO₂ laser treatment, the rate of pathological grade reduction was 93.7% (569/607). Among them, the pathological grade reduction rates of CIN, VaIN and CIN with VaIN were 93.6% (422/451), 98.1% (102/104) and 86.5% (45/52), respectively. Multiple unconditional logistic regression analysis showed that the location of CO₂ laser treatment was cervix with vagina (OR=11.727, 95%CI: 1.337-102.859, P=0.026), which was an independent risk factor for CIN and/or VaIN patients′ pathological grade reduction after CO₂ laser treatment.

CO₂ laser treatment of CIN and (or) VaIN is safe and effective. After treatment of CO₂ laser, HPV becomes negative and the pathological grade decreases due to different factors in CIN and (or) VaIN patients.

To explore the clinical efficacy and safety between atosiban and ritodrine in treatment of preterm labour.

The relevant data base were searched according to the principles of systematic review to collect all the randomized controlled trials(RCT) involving treatment of preterm labour using atosiban and ritodrine. According to treatment strategies, the subjects were divided into atosiban group and ritodrine group. Meta-analysis of including studies was performed by Rev Man 5.1 software.

A total of 4 pieces RCT were included with 420 subjects．①Three of them were English literature, RCT with high quality included patients of preterm labour．The Meta-analysis showed there were no statistic differences in tocolytic efficacy, gestational age at delivery, birth weight of neonatal, rates of neonatal asphyxia or perinatal death between two groups (P>0.05) ．The incidence of maternal tachycardia and early drug termination due to adverse events in atosiban group were substantially lower than those in ritodrine group [RR=0.02, 95% CI(0.01-0.08) , P<0.01; RR=0.03, 95% CI(0.01-0.15) , P<0.01], respectively．②One Chinese study with relatively lower quality included patients of threatened preterm labour．A descriptive analysis conducted independently showed that there were no significant differences between two groups in time-to-effect, prolonged pregnancy duration, tocolysis rate, full-term delivery rate, birth weight or adverse events rate (P>0.05) .

Atosiban treatment of preterm labour was better than that of ritodrine. There had difference between domestic and abroad studies in term of incidence of adverse events. It is quite necessary to perform more high-quality and large-scale RCT in combination with cost-effectiveness evaluation to assess the exact clinic value of atosiban in treatment of preterm labour more reliably.

With the accelerated pace of life, changes in diet, accumulation of bad habits, increased mental stress and environmental deterioration have posed a great threat to males′ health. Infertility has become a common disease with high incidence. Infertile women or men of childbearing age and pregnant couples often hope that doctors can give them dietary guidance. At present, there are many studies on the rational nutrition supplement for women before pregnancy, and there have been many progresses. However, there are few studies on the rational nutrition supplement for men preparing for childbirth. This paper summarizes some nutrients related to male fertility in the current studies, such as minerals (zinc, iron, calcium, magnesium, selenium), vitamins (vitamin A, B9, B12, C, D and E), and other important auxiliary nutrients (L-carnitine, lycopene, amino acids, coenzyme Q10, fructose, citric acid), hoping to give guidance to the males preparing for childbirth.

To study the clinical characteristics and pregnancy outcomes of listeriosis during pregnancy in order to improve the obstetricians′ understanding of the disease and the prognosis of patients and their newborns.

A total of 14 patients of listeriosis during pregnancy from April 2011 to August 2018 in Sichuan Provincial Hospital for Women and Children, were chosen as research subjects. Their clinical case data were analyzed retrospectively, including general conditions, clinical symptoms, laboratory results, antibiotics treatment and pregnancy outcomes of patients, and general conditions of fetus or newborns, also clinical symptoms, treatments and outcomes of alive newborns. Spearman rank correlation analysis method was used to analyze the correlation between rash and death of alive newborns infected by Listeria monocytogenes (LM). Mann-Whitney U test was used to compare the time of first use of antibacterials between cured and dead newborns who were live birth and infected by LM. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

①The average age of 14 patients of listeriosis during pregnancy was 29.3 years old, ranging from 21 to 40 years old, and the average gestational age at onset was 31^{+ 2} weeks. Three cases of them occurred in the second trimester and the other 11 cases occurred in the third trimester of pregnancy. Fever of patients and fetal movement abnormalities were the most common clinical symptoms of patients of listeriosis during pregnancy, the ratio of these two clinical symptoms were 85.7% (12/14) and 64.3% (9/14), respectively. Other clinical symptoms including abdominal pain (57.1%, 8/14), uterine tenderness (35.7%, 5/14) of patients, etc.. Among the 11 patients of listeriosis during pregnancy in the third trimester, there were 9 cases (81.8%, 9/11) of abnormal of fetal monitoring and 9 cases (81.8%, 9/11) of amniotic fluid. ② The samples of LM detected in our study were blood, amniotic fluid and cervical secretions of patients of listeriosis during pregnancy, and blood and cerebrospinal fluid of their newborns. Among 8 cases of 14 patients of listeriosis during pregnancy who took placenta pathological examinations, all of them were acute chorioamnionitis. ③ All the 14 patients of listeriosis during pregnancy were treated by anti-infection and their prognosis was favorable. However, among 15 cases of fetuses or newborns (including twins) of 14 patients of listeriosis during pregnancy, 11 cases (73.3%) were live births, and among them, 5 cases were cured and 6 cases died. The mortality of 15 fetuses or newborns was 66.7% (10/15). ④The correlation analysis showed that there was a correlation between rash and death of alive newborns infected by LM (r=0.633, P=0.036). There was no significant differences between cured and dead newborns who were live birth and infected by LM in the time of first use of antibacterials (Z=—0.471, P=0.638).

Patients of listeriosis during pregnancy has no specific clinical manifestation. The empirical antibiotic therapy before final diagnosis has poor therapeutic effect. The prognosis of patient of listeriosis during pregnancy after treatment by anti-infection is favorable, but the prognosis of its newborn is poor.

To explore the prenatal diagnosis, gene mutation types and pregnancy outcome of fetal hemoglobin (Hb) H disease in Guangxi Zhuang Autonomous Region.

A total of 440 fetuses diagnosed with Hb H disease were selected as research subjects in the Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region from January 1, 2015 to December 31, 2019. The genomic DNA of fetuses and their parents was extracted by DNA extraction kit. Three common deletion mutations of α-Thalassemia genes (--^SEA, -α^3.7, -α^4.2) were detected by gap-crossing PCR (Gap-PCR), and the common α- and β-Thalassemia genes point mutations were detected by PCR-reverse dots blot hybridization. For couples whose test results of the above-mentioned conventional methods were normal while Thalassemia screening suggesting a high risk, multiplex ligation-dependent probe amplification (MLPA) or DNA sequencing technology was used for further testing.The detection rate of fetal Hb H disease from 2015 to 2019 was compared using linear-by-linear association chi-square test.The procedure followed in this study complied with the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

①In this study, the overall detection rate of fetal Hb H disease was 9.95% (440/4 421). There was no statistically significant difference in the detection rates of fetal Hb H disease from 2015 to 2019 (P>0.05). ②Among 440 Hb H disease fetuses, the top 4 Hb H disease genotypes were -α^3.7/--^SEA, α^CSα/--^SEA, -α^4.2/--^SEA and α^WSα/--^SEA, which accounting for 39.32% (173/440), 30.23% (133/440), 14.09% (62/440) and 10.91% (48/440), respectively. In addition, 32 cases of Hb H disease fetuses were detected with β-Thalassemia gene mutations, and 20 cases were detected with β^CD41-42/β^N genotype, 6 cases with β^CD17/β^N, 2 cases with β^CD17/β^CD17 genotype, 2 cases with β^CD71-72/β^N, 1 case with β^CD43/β^N, and 1 case with β^-28/β^N.③Among 440 pregnant women with fetal Hb H disease, 1 case (0.23%) had spontaneous abortion, 228 cases (51.82%) chose artificial termination of pregnancy; 135 cases (30.68%) had spontaneous delivery, 65 cases (14.77%) gave birth by cesarean section; and 11 cases (2.50%) had an unknown pregnancy outcome.

The detection rate of fetal Hb H disease in Guangxi Zhuang Autonomous Region is 9.95% (440/4 421). There are various types of gene mutations, and some of them are combined with β-Thalassemia gene mutations. The proportion of pregnant women with fetal Hb H disease choosing artificial termination of pregnancy is high. Extensive implementation of Thalassemia screening and prenatal genetic diagnosis for the fertile population is of great significance for prevention and control of birth defects in Hb H disease.

As we know, 8-hydroxy-2′-deoxyguanosine (8-OHdG) is one of the oxidative damage products of DNA. The level of 8-OHdG can reflect the degree of oxidative damage in the body, and it is recognized internationally as one of new indicators and biomarkers for evaluating DNA oxidative damage and oxidative stress (OS) state. This study will focus on the detection method of 8-OHdG, and the research progress of 8-OHdG in OS and childhood-related diseases, in order to provide a reference for the diagnosis and treatment of those disease.

Along with the increasing of influence factors of female hormone secretion, and the increasing risks of food quality and safety in China, the incidence of polycystic ovary syndrome (PCOS) is increasing year by year gradually. PCOS has a great impact on women's health. PCOS not only affects the female patients themselves, infertility caused by PCOS but also directly relateds to the health of their off-springs. To study the pathogenesis mechanism and treatment strategies of PCOS has become a hot issue in clinical research. Recent studies have confirmed that through reducing fat by exercises, other lifestyle adjustments, and long-term interventions could play a positive role on PCOS patients. At present, treatment strategies of PCOS are multi-faceted, in order to improve the life quality of PCOS patients. The article focuses on revealing the mechanism of PCOS and research progress of risk factors associated with PCOS and impact of reducing fat by exercises on patients.

To explore the incidence of various inborn errors metabolism (IEM) in newborns in minority nationality regions of Hainan Province.

A total of 37 482 newborns born from January 1, 2018 to January 31, 2020 in minority nationality regions of Hainan Province were selected as research subjects. All guardians of these newborns agreed to be screened for IEM. Tandem mass spectrometry was used to screen neonatal heel blood (dried blood spots of disk bioassay) for various IEM. For part of newborns whose screening results were suspicious of IEM, their peripheral blood were collected and sent out for genetic testing to confirm the types of IEM and genetic mutations.The lowest incidence of IEM between male and female children in minority nationality regions of Hainan Province were compared statistically by chi-square test. This study was approved by the Medical Ethics Committee of Hainan General Hospital [Approval No. Medical Ethics (2018) No. 14].

① Among 38 586 live births in research regions during the research period, there were 37 482 cases received IEM screening, and the coverage rate of neonatal IEM screening was 97.1%. ②Among 37 482 newborns, 89 of them were suspected of IEM. Among 89 suspected of IEM newborns, 24 of them were conducted genetic testing, and 19 were firmly diagnosed as IEM. The diagnostic rate of IEM in 24 suspected newborns was 79.2% (19/24).Because only part of newborns with suspected IEM received genetic testing, the lowest incidence of IEM among newborns in the research regions was 51/100 000 (19/37 482). In this study, the lowest incidence of IEM were 57/100 000 (12/21 136) for males and 43/100 000 (7/16 346) for females newborns, and there was no significant difference between them (χ²=0.354, P=0.552). ③ Among 19 newborns with firmly diagnosis of IEM all had gene mutations, and there were 5 cases of aminoacidopathy, 5 cases of organic acid metabolism disorder, 2 cases of urea circulation disorder and 7 cases of fatty acid β oxidation metabolism disorder, respectively.

The incidence of IEM in newborns in the research regions was relatively high and with many types.We suggest that various IEM screening should be carried out among newborns in minority nationality regions of Hainan Province to improve life quality of IEM newborns.

To investigate the clinical significance of the prevalence of thyroid-related antibodies in childhood systemic lupus erythematosus (cSLE) patients for the detection of thyroid injury and autoimmune thyroiditis (AITD).

Fifty children with first-onset cSLE who were hospitalized at the Department of Rheumatology and Immunology, Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2017 to August 2021 were selected into this study and included in cSLE group. Another fifty healthy children who underwent physical examination at same hospital were also selected and included in control group. The general clinical data and positive rate of thyroid-related antibodies of 2 groups were retrospectively analyzed. Moreover, the clinical characteristics, positive rate of thyroid-related antibodies, thyroid injury, treatment and follow-up of patients in cSLE group were retrospectively analyzed. Thyrotropin receptor antibody (TRAb), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) were detected by electrochemiluminescence method. The procedure followed in this study was in line with the requirements of the Helsinki Declaration of the World Medical Association revised in 2013. Informed consent for clinical research was obtatin from each patient′s guardians.

① There were no significant differences in general clinical data such as gender ratio and age between two groups (P>0.05). ② Among 50 children in cSLE group, the age ranged from 4 to 15 years old [(11.0±2.5) years old], and all the 50 children had negatime family history of thyroid diseases. At the first visit, Systemic Lupus Erythematosus Disease Activing Index (SLEDAI-2k) of all children were higher than 5, and only one patient presented with thyroid injury. TRAb, TgAb and TPOAb were positive in 6 cases (12.0%), 18 cases (36.0%) and 20 cases (40.0%) of 50 children with cSLE, respectively. There were no significant differences in the positive rates of thyroid-related antibodies among cSLE children with different disease activities (P>0.05). ③ The positive rates of three thyroid-related antibodies in cSLE group were higher than those in control group, and the differences between two groups were statistically significant (P<0.05). ④ Among 50 children in cSLE group, 13 case (26.0%, 13/50) were diagnosed as AITD, including 12 cases (24.0%, 12/50) were Hashimoto′s thyroiditis (HT) and 1 case (1/50, 2.0%) was Graves disease (GD); 2 cases (2/50, 4.0%) were diagnosed as hypothyroidism (subclinical type); 9 cases (9/50, 18.0%) had no symptoms of thyroid diseases, and their thyroid function and ultrasonic examination results were normal, although thyroid-related antibodies were positive. The remaining 26 cases had no thyroid injury. ⑤After treatment with glucocorticoids and immunosuppressants, cSLE in 50 children was relieved from 6 months to 18 months after treatment (SLEDAI-2k score <5). Among them, 13 cases with cSLE complicated with AITD were given levothyroxine or methimazole orally. After 6 to 48 months of follow-up, the symptoms disappeared, the thyroid function returned to normal, and the thyroid-related antibodies turned negative or even medication discontinuation. Two cases with cSLE complicated with hypothyroidism and negative thyroid-related antibodies were given oral levothyroxine. With the remission of the primary disease, thyroxine tablets could be reduced, and the thyroid-related antibodies did not turn positive.

Thyroid injury is more common in children with cSLE, most of whom have AITD, with HT predominating, but most thyroid injuries are insidious. Therefore, for children with newly diagnosed cSLE, especially those with active SLE, thyroid autoantibodies should be routinely detected in addition to thyroid function, regardless of whether SLE is severely active or not. Once thyroid injury is found, cSLE should be actively controlled, and thyroxine or methimazole should be taken as symptomatic treatment. With the remission of cSLE, thyroid-related antibodies can turn negative and thyroid function can be restored.

To explore clinical effects of bioelectric stimulation on endometrial repair after artificial termination of pregnancy.

From January 2017 to June 2018, a total of 100 patients who underwent artificial termination of pregnancy in Huai′an Women and Children Health Hospital were selected as research subjects. According to the random number table method, they were divided into observation group (n=50, treated with bioelectric stimulation) and control group (n=50, treated with oral drospirenone ethinyl estradiol). The general clinical data, endometrial thickness, uterine spiral artery pulsatility index (PI) and resistance index (RI) were observed before and after treatment. This study complies with the requirements of the Helsinki Declaration of the World Medical Association revised in 2013, and was approved by the Ethics Committee of Huai′an Women and Children Health Hospital (Approval No. 2016008). Informed concent was obtained from each participates.

① There were no significant differences between two groups in the aspects of age, times of artificial termination of pregnancy and body mass index (BMI) (P>0.05). ② After treatment, the endometrial thickness of observation group was (9.8±2.8) mm, which was thicker than that of control group (8.0±2.5) mm, and the difference was statistically significant (t=7.012, P=0.007). In addition, there were significant differences in endometrial thickness before and after treatment of observation group and control group, respectively (t=15.619, 12.952, P<0.001, <0.001). ③ After treatment, PI and RI of uterine spiral artery of observation group were 1.0±0.1 and 0.7±0.1, respectively, which were significantly higher than those of control group (0.9±0.1 and 0.6±0.1, respectively), and the difference between two groups was statistically significant (t=4.106、2.028, P=0.003, 0.016). In addition, there were significant difference in PI and RI of uterine spiral artery before and after treatment of observation group and control group, respectively (observation group: t=3.261, 12.432, P=0.010, <0.001; control group: t=3.065, 10.307, P=0.021, <0.001).

The effect of bioelectric stimulation on endometrial repair was better than that of oral drospiroone ethinylestradiol treatment. Because this study is just a retrospective study, the clinical application value of this technology needs to be confirmed by the results of large sample, multicenter and randomized controlled study.

Bronchopulmonary dysplasia (BPD) is a serious pulmonary complication that affects the survival rate and quality of premature infants. Early diagnosis of BPD is critical to improve the survival rate and prevent chronic lung remodeling of premature infants. So finding appropriate biomarkers for early diagnosis of BPD has always been the focuses of this field. But the recent studies of BPD biomarkers are mostly focused on the perspective of lung inflammation and infection, lung fibrosis and oxidative stress, which are the pathological physiological characteristics of typical BPD, rarely in terms of pulmonary alveoli development block and pulmonary microcirculation disturbance of lung, which are typical characteristics of pathological physiological of " new" BPD. Recent studies have shown that there may be some relationship between " new" BPD and pulmonary alveoli related biomarkers of Krebs Von den lungen-6 (KL-6) and Clara cell secretory protein (CC16), and pulmonary microvascular related biomarkers of vascular endothelial growth factor (VEGF), angiopoietin (Ang) and endostatin (ES), which may probably be the appropriate biomarkers to predict the development of " new" BPD. In addition, the omics related biomarkers of BPD have received more and more attentions in recent years. So, in this article, the authors will review the recent research advances of biomarkers of " new" BPD in terms of pulmonary alveoli development, pulmonary micro-angiogenesis and omics, which may contribute to early prevention and treatment of BPD and improve prognosis and life quality of these premature infants.

To investigate the clinical performance of non-invasive prenatal testing (NIPS) in the detection of chromosome aneuploidies and genome-wide copy number variation (CNV).

A total of 50 975 serum specimens from singleton pregnant women who received NIPS at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2018 to December 2019 were selected into this study. Based on different risk factors, they were divided into 3 groups. Those with serologic screening results of high risk + elderly pregnant women + adverse maternal history/family history were included in high-risk group (n=22 852), those with moderate risk/critical risk of serologic screening and abnormal ultrasound soft indicators were included in moderate-risk group (n=4 584), and those without the above risk factors were included in low-risk group (n=23 539). For those with high risk of NIPS detection, chromosome karyotype analysis and chromosome microarray analysis (CMA) were used for interventional prenatal diagnosis. The study protocol was approved by the Ethics Review Committee of Guangxi Maternal and Child Health Hospital (approval No.[2020]9-2).

① Of 50 975 pregnant women who underwent NIPS, 702 cases showed high risk, with a total positive rate of 1.38%. Among them, the high risk of 21-, 18-and 13-trisomy was 175 cases (0.34%), 67 cases (0.13%) and 63 cases (0.12%), respectively, the high risk of sex chromosome aneuploidy abnormalities (SCA) was 205 cases (0.40%), the high risk of rare chromosome number abnormality (RCA) was 96 (0.19%), and the high risk of copy number variation (CNV) was 96 (0.19%). ②A total of 555 of the 702 positive cases (79.06%) were followed up by karyotyping and (or) CMA, 93 (16.76%) refused confirmatory diagnosis, 42 (7.57%) did not perform prenatal diagnosis because of abortion or induced labor, and 12 (1.71%) lost follow-up. ③The positive predictive values for trisomy 21, trisomy 18, trisomy 13, SCA, RCA, and CNV were 85.09% (137/161), 57.14% (28/49), 16.67% (9/54), 42.31% (66/156), 5.56% (4/72), and 42.86% (27/63), respectively. ④In 16 cases with high risk of NIPS screening, NIPS was not detected by interventional prenatal diagnosis, but other abnormal results were detected. Of the 4 fetuses with high risk of trisomy 21, CNV was detected in 3 and complex structural variation of chromosome 21 was detected in 1. In one case of 18-trisomy high-risk fetus, the karyotype analysis results suggested that it was 21-trisomy. Among the 2 fetuses with 13-trisomy high risk, one was a chimera with chromosome structural variation, and the other was CNV. CNV of other chromosomes was detected in 3 fetuses with high SCA risk and 2 fetuses with high RCA risk. Among the 4 fetuses with high risk of CNV, 47, XYYY were detected in 1 case and other CNV abnormalities were detected in 3 cases.

NIPS has a high clinical value for screening common chromosomal aneuploidies such as 21-, 18-, and 13-trisomies. the positive predictive value of NIPS for screening SCA, RCA and CNV is low, but combined with prenatal ultrasound and other related examination, it can provide a basis for genetic counseling and further prenatal diagnosis.

To investigate clinical characteristics, diagnosis, treatment and prognosis of familial acute necrotizing encephalopathy (ANE1) caused by RANBP2 gene mutation.

A total of 2 children with ANE1 caused by RANBP2 gene mutation who were confirmed in Beijing Children′s Hospital in January 2018 (case 1) and in Sichuan Provincial Hospital for Women and Children in March 2019 (case 2), were chosen as research subjects. We retrospectively analyzed their clinical case data, including clinical manifestations, laboratory examination results, head MRI features, treatment and follow-up data. Meanwhile, literature related to ANE1 caused by RANBP2 gene mutation were searched in mainstream databases for literature review. And the procedure followed in the whole study were in accordance with World Medical Association Declaration of Helsinki revised in 2013.

① Clinical case data: clinical manifestation of case 1 was presented with headache after fever, drowsiness, poor mental response, indifferent expression, unstable walking in a straight line, and recent memory decline; and of case 2 with fever, headache, vomiting, progressive disturbance of consciousness and facial paralysis after infection of influenza A virus. Their head MRI examinations revealed symmetrical damage to multiple parts of thalamus, insula, pons and external capsule, with some cystic changes. Their gene detection results showed that heterozygosity mutation of RANBP2 gene on exon 12: c. 1754 C>T (p.Thr585Met), a missense mutation. After treatment with gamma globulin, glucocorticoids to regulate immunity, and " mitochondrial cocktail therapy" to repair mitochondrial function, their intracranial lesions improved, and mental and athletic abilities were restored. ② Clinical features of ANE1 caused by RANBP2 gene mutation of 74 cases by literature review and 2 cases in this study were summarized. Their clinical features were as follows: their age of onset ranged from 5 months to 40 years old, median age of first onset was 3.5 years old, the ratio of male to female patients was 35∶41. Among main clinical manifestations, ratio of fever was 82.5% (47/57), epilepsy was 81.1% (41/53), focal neurological deficit (FND) was 28.6% (8/28), encephalopathy was 93.4% (71/76), elevated CSF protein (EP) was 90.3% (56/62), pleocytosis in CSF (Pl) was 28.6% (8/28). Head MRI/CT showed that main lesions of patients were located in thalami (83.1%, 49/59), brainstem (72.9%, 43/59), temporal lobe (71.2%, 42/59), cerebellum (26.3%, 5/19), spinal cord (13.8%, 4/29), basal ganglia (8.5%, 5/59).

ANE1 caused by RANBP2 gene mutation has typical clinical features and characteristic head MRI findings. Febrile disease with symmetrical lesions in thalamus and other brain parts should be a vigilant signal to ANE1 patients. For patients suspected of ANE1, early detection of RANBP2 gene will be helpful to clarify diagnosis, rational treatment and improve their prognosis.

To investigate the predictive value of serum lactate dehydrogenase (LDH) levels within 24 hours (hereinafter referred to as 24 h-LDH level) on the degree and prognosis of sepsis for the children admitted to the pediatric intensive care unit (PICU).

A total of 326 children with sepsis who were hospitalized in the PICU of West China Second University Hospital, Sichuan University from May 4, 2015 to December 31, 2016 were collected as research subjects. Clinical data were retrospectively analyzed, including age, hospital stay, 24 h-LDH levels, affected organs /systems of primary infectious disease, organ damage, discharge outcomes, etc.. The Wilcoxon rank sum test or Kruskal-Wallis H rank sum test were used to compare the age, hospital stay, 24 h-LDH levels of children, and so on. Spearman rank correlation analysis was used to analyze the correlation between 24 h-LDH levels, sepsis severity, the occurrence of multiple organ dysfunction (MODS) and discharge outcomes, and so on. The receiver operating characteristic (ROC) curve was drawn to predict severe sepsis, septic shock (SS), MODS and death of children with sepsis by 24 h-LDH levels, and the area under the ROC curve (AUC) was calculated. According to the maximum principle of Youden index, the optimal cut-off value of 24-h LDH levels were determined to predict severe sepsis, SS, MODS and death, and the sensitivity and specificity of the prediction of the above indicators were calculated. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

①The incidences of MODS in children with sepsis, severe sepsis and SS were 27.5% (30/109), 68.8% (121/176) and 78.0%(32/41), and the mortality rates were 0, 8.0%(14/176) and 22.0% (9/41), respectively. ②The median 24 h-LDH levels of children with sepsis, severe sepsis, and SS were 718 U/L (560-976 U/L) and 871 U/L (666-1 972 U/L) and 1 588 U/L (799-2 150 U/L), respectively, the differences among them was statistically significant (χ² = 27.445, P=0.008). The median 24 h-LDH levels of sepsis children with MODS was 713 U/L (571-967 U/L), which was significantly lower than that of sepsis patients without MODS 1 002 U/L (706-2 150 U/L), and the difference was statistically significant (Z=—5.745, P<0.001). The median 24 h-LDH levels of children with recovery, improvement, abandonment treatment and death were 712 U/L (584-945 U/L), 824 U/L (605-1 200 U/L), 1 311 U/L (716-2 150 U/L) and 2 150 U/L (1 380-2 150 U/L), respectively, the difference was statistically significant (χ² =38.105, P<0.001). ③The results of Spearman rank correlation analysis showed that 24 h-LDH levels were positively correlated with sepsis severity and the occurrence of MODS (r_s=0.290, 0.319; P<0.001). The level of 24 h-LDH were negatively correlated with the discharge outcomes of children with sepsis (r_s=-0.387, P<0.001). ④ROC curve analysis results showed that the ROC-AUC of 24 h-LDH levels predicted severe sepsis, SS, MODS were 0.658 (95%CI: 0.598-0.719, P<0.001), 0.671 (95%CI: 0.583-0.759, P<0.001), 0.685 (95%CI: 0.628-0.742, P<0.001) and 0.788 (95%CI: 0.698-0.879, P<0.001), respectively. According to the maximum principle of the Youden index, when the above four conditions occur, the optimal cutoff values of serum LDH in children were 1 294.0 U/L, 1 307.0 U/L, 1 318.5 U/L, and 1 323.0 U/L (the upper limit of normal reference value of serum LDH level was 618 U/L). And the sensitivity for predicting severe sepsis, septic shock, MODS and death in children were 39.2%, 63.4%, 43.7%, 82.6%, respectively, and the specificity were 87.2%, 74.7%, 78.2% and 73.9%, respectively. ⑤The incidence of MODS in sepsis children with sepsis with 24 h-LDH levels > 1 236 U/L was 4.565 times higher than those with 24 h-LDH levels ≤ 1 236 U/L (OR=4.565, 95%CI: 2.662-7.830, P<0.001). ⑥Compared with the probability of death, abandonment, improvement and complete recovery of patients, the 24 h-LDH levels > 1 236 U/L, which were 25.175 times (OR=25.175, 95%CI: 7.741-81.875, P<0.001), 5.979 times (OR=5.979, 95%CI: 3.142-11.380, P<0.001), 1.619 times (OR=1.619, 95%CI: 0.824-3.182, P=0.162) higher than the 24 h-LDH levels ≤1 236 U/L, respectively.

The 24 h-LDH levels in children with sepsis is related to the severity of sepsis, the occurrence of MODS and discharge outcomes. Especially, the 24 h-LDH levels > 1 236 U/L, which can be considered as a potential biomarker for the prognosis and predicting whether MODS occurs in children with sepsis.