To explore clinical epidemiological and imaging data of a 2⁺ -month-old infant with corona virus disease 2019 (COVID-19) by imported and familial cluster infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and review the literatures.

The 2⁺ -month-old infant with COVID-19 who was admitted to the First People′s Hospital of Jintang County, Sichuan Province on February 7, 2020 were selected as the study subject. Clinical data of the infant with COVID-19 were collected by retrospective analysis method, and clinical epidemiological characteristics and imaging data, diagnosis, treatment protocol and prognosis were analyzed. With the keywords of " infant" " 2019 novel coronavirus (2019-nCoV)" " novel coronavirus pneumonia (NCP)" " SARS-CoV-2" and " COVID-19", literatures related with COVID-19 infants were retrieved from PubMed, Medline, China National Knowledge Infrastructure, VIP database, Wanfang Data Knowledge Service Platform, and on public platforms such as the " medical pediatric channel" and news websites. Literatures retrieval time was set from December 1, 2019 to February 21, 2020. Clinical characteristics, diagnosis, treatment protocols and prognosis of COVID-19 infants were summarized. This study was consistent with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

①The results of medical history collection, diagnosis, and treatment of the infant were as follows: infant, male, two months and 29 days old. On January 18, 2020, the infant′s aunt came back from Wuhan the outbreak centre of epidemic to Sichuan Province. After close contact, the infant developed symptoms, such as shortness of breath, slight cough, and diarrhea. The results of the Mycoplasma pneumonia, Chlamydophila pneumonia, influenza A and B virus antigens all were negative after admission. Chest CT examination results showed that multiple subpleural light ground glass opacities were found in both lungs. Two times of nasopharyngeal swabs of SARS-CoV-2 both were positive with RT-PCR test, and the infant was confirmed as COVID-19 based on epidemiological data, clinical manifestations, imaging findings, and RT-PCR test results. Clinical symptoms of shortness of breath and cough disappeared, lung lesions absorbed on chest imaging, and RT-PCR test turned to negative after symptomatic treatment of the infant. Currently, the infant was observed continually and waited for discharge. ②Literatures review results revealed that 5 literatures and 2 news reports about infant COVID-19 in China were retrieved according to the literature search strategy in this study, involving the clinical characteristics, diagnosis, treatments and prognosis of 18 cases of infants with COVID-19. All of the 18 cases showed epidemiological characteristics of imported and familial cluster infection (with a history of contact with Wuhan COVID-19 patient). Among the 18 cases, there were 3 neonates whose mothers were infected with SARS-CoV-2. Among the 3 neonates, 2 cases were effectively quarantined without any contact with infected patients. Initial symptoms of the 18 cases were as follows: fever in 5 cases (27.8%), cough and lower respiratory symptoms in 3 cases (16.7%), sneezing and vomiting milk in 1 case (5.6%), asymptomatic in 3 cases (16.7%), and unknown in 6 cases (33.3%). There were 7 infants with report of chest CT examinations results, and CT images results of them all were abnormal with increased bronchovascular shadows, ground glass opacity, and/or consolidation of bilateral or unilateral lung. Among them, 16 cases had satisfying prognosis except for 2 cases with no prognostic data, and no death was reported.

COVID-19 infants reported in literatures and the infant included in this study all have the characteristics of imported and familial cluster infection characteristics. As for newborn patients, the possibility of vertical transmission from mother to child still cannot be excluded. In addition, clinical symptoms of infant patients are mild, the pulmonary lesions are small and limited, and their prognoses are relatively good. During the outbreak of COVID-19, the protection of children, especially infants should been strengthened, and avoid imported, familial cluster infection of SARS-CoV-2.

To explore the feasibility of clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation, as well as the maternal and neonatal outcomes.

The literature of clinical pregnancy in the transplanted uterus and successful deliver living neonate after uterus transplantation were selected as research subjects. Using " uterine transplantation" or " uterus transplantation" as English search terms, and " uterine transplantation" and " live birth" as Chinese search terms, we searched literature about clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation from PubMed, Wanfang Data Knowledge Service Platform and China National Knowledge Infrastructure databases, and the search period was set from the establishment of each database to December 2018. The clinical case data of reported patients who received uterus transplantation (recipients) from these literature were analyzed, including general clinical data, complications during pregnancy, childbirth and postpartum conditions of the recipients, also maternal and fetal outcomes, and conditions of live birth neonates.

① A total of 15 pieces of literature which met the inclusion and exclusion criteria of this study were selected, and all of which were reported from abroad. A total of 12 recipients who had clinical pregnancy and successfully deliver living neonate after uterus transplantation were involved in, and they delivered 12 live birth neonates. ② General clinical data of recipients: 66.7% (8/12) of recipients received a uterus transplantation in Sweden and successfully delivered living neonate. 90.9% (10/11) of recipients received uterus transplantation due to Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. 58.3% (7/12) of recipients and the donors were related. 91.7% (11/12) adopted living donor transplantation, and 1 case adopted dead donor transplantation. 12 recipients were pregnant through in vitro fertilisation-embryo transfer (IVF-ET) and all had single embryo transfers. During pregnancy of recipients, immunosuppressive therapy was used to prevent graft versus host reaction, and cervical biopsy was used for immune monitoring. ③ Recipients′ conditions of pregnancy period, childbirth and postpartum: The main obstetric complications during pregnancy were hypertensive disorders of pregnancy and intrahepatic cholestasis of pregnancy (ICP). The average gestational age at delivery of 10 recipients was 34⁺ gestational weeks. The delivery modes of 12 recipients were cesarean section, and there were no serious complications, such as intraoperative bleeding and postpartum hemorrhage after 24 h of cesarean section, death etc., 75.0% (9/12) of recipients continued to retain uterus, and one of them succeeded in pregnancy again. ④ Live birth neonatal conditions: The average weight of 11 neonates was 2 497 g among 12 live birth neonates; no birth defects were found in 12 neonates, only 1 neonate had mild respiratory distress and the rest did not have complications. The follow-up age of 8 neonates in Sweden ranged from 2 months to 3 years, and no obvious abnormalities were found.

There is a possibility of clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation, and both recipient and neonate have good prognosis. Recipients must be taken active management in strict accordance with high-risk pregnancy.

Endometriosis (EMs) is a common disease that seriously perplex the women of childbearing age at present. Because of its complicated pathogenesis, unknown etiology and characteristics of easy implantation and recurrence similar to tumor, there is still no definite diagnosis and treatment strategies for EMs. Recent studies have found that EMs is an autoimmune disease and closely related to T cell immunity. The helper T cell (Th) 17 and regulatory T cell (Treg) are two important subtypes of CD4⁺ T cells. The imbalance of Th17/Treg and imntraperitoneal environment affected by the imbalance of two cells proportion are related to the occurrence and degree of EMs, and also related to infertility of EMs. In this article, we focus on the latest research status of Th17/Treg and immune-internal environment imbalance in EMs.

To investigate the clinical characteristics of methylmalonic acidemia (MMA) and review the related literatures, aiming at improving the clinicians′ recognition of MMA.

On November 2, 2016 and February 25, 2017, two children with MMA who were misdiagnosed as hematological diseases were selected as research subjects. The clinical data of this 2 children were collected from Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University. Their ages were 5-month and 15-year old, respectively. A retrospective analysis of the diagnosis and treatment processes of the 2 children with MMA was conducted, and a search strategy was set. The key words were " methylmalonic academia" " misdiagnosis" " blood routine" and " MMA" . Literatures on MMA were searched in Wanfang Database, China National Knowledge Infrastructure (CNKI) Database, etc.. The retrieval period was from January 1, 2000 to December 31, 2017. The genetic metabolic disease gene Panel sequencing based on high-throughput sequencing technology was used to analyze the mutation of the pathogenic gene. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

①Case 1 was misdiagnosed as small cell hypochromic anemia at 1 month old, and she was diagnosed as MMA at 5 months old. The results of high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) showed that propionylcarnitine (C3) was 3.2 μmoL/L, C3/ acetylcarnitine (C2) was 0.34, C3/free carnitine (C0) was 0.22. The results of urine gas chromatography-mass spectrometry (GC/MS) showed that the urine methylmalonic acid value was 20 μg/μmoL creatinine. The concentration of serum homocysteine (Hcy) was 40 μmol/L. Blood routine examination showed hemoglobin (Hb) was 105 g/L. The results of gene detection indicated that the mutation site of the gene was MMACHC c. 80G>A/c.609G>A. This girl was finally diagnosed as MMA complicated with hyperhomocysteinemia, belonging to cblC type. ② Case 2 was misdiagnosed as thrombocytopenia at 6 months old, and this boy was diagnosed as MMA at the age of 15. HPLC-MS/MS results showed that C3 was 7.22 μmo/L, C3/C2 was 0.32, C3/C0 was 0.82. Urine GC/MS results showed that urine methylmalonic acid was 14.02 μg/μmoL creatinine. Serum Hcy concentration was 80 μmol/L. Blood routine examination showed that Hb was 103 g/L and platelet count was 85×10⁹/L. The results of gene detection indicated that mutation site of the gene was MMACHC c. 482G>A/c.609G>A. This boy was finally diagnosed as MMA complicated with hyperhomocysteinemia, belonging to cblC type. ③The two children were misdiagnosed as hematological diseases and received treatment such as blood transfusion, iron treatment and hormone administration, etc., with no obvious clinical effects. After two children were diagnosed with MMA, they were given intramuscular injection of hydroxycobalamin (1 mg/d) and oral administration of L-carnitine, betaine and calcium folinate for 1 month. The results of blood routine examination showed that all indexes were within the normal reference range and the condition was stable.

The clinical manifestations of MMA are nonspecific, and some children are easily misdiagnosed as blood system diseases. Blood HPLC-MS/MS, urine GC/MS and gene detection are effective methods for diagnosing MMA.

To investigate clinical features and treatment of hematological malignancies combined with invasive fusariosis in children, and to review the literatures.

On July 15, 2016, a 13-year-old girl with myelodysplastic syndromes (MDS) and invasive fusariosis who was hospitalized in the Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University was chosen as study subject, and its clinical features were analyzed. With the following key words of " malignant" " blood system disease" and " invasive fusariosis" as Chinese key words, and " malignant, hematologic disease" and " invasive fuasriosis" as English key words, the literature of hematological malignancies combined with invasive fusariosis were searched from Pubmed database, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP database. Literature retrieval time ranged from Janury 1, 2010 to December 31, 2016, and clinical features of searched literatures were summarized. This study was consistent with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

①This was a case report of MDS with invasive fusariosis based on clinical manifestations and related laboratory findings. After chemotherapy, there were pulmonary infiltrates and limbs, purple-red nodules on the trunk with central necrosis, followed by multiple subcutaneous fluid masses on the extremities. Skin biopsy, bone marrow culture, and mass drainage culture all indicated Fusarium infection. Amphotericin B combined with posaconazole were given to the child. The child was followed up until April 5, 2017, her families gave up treatment and discharged because the primary basic disease could not be relieved. ② The results of setting a retrieval strategy to search relevant literatures showed that a total of 7 domestic and foreign literatures reported a total of 21 children with hematologic malignancies and invasive fusariosis. Among them, 12 were male and 9 were female. The main clinical manifestations were persistent fever, ineffective active anti-infection treatment and poor prognosis. Of the 21 children, 14 died and 7 were cured.

Children with hematological malignancies combined with invasive fusariosis should be diagnosed early and given effective and sufficient antifungal treatment. Amphotericin B combined with posaconazole may be one of the options for the treatment of invasive fusariosis..

To explore the clinical characteristics of children with Dent -1 disease and review the related literatures to improve the clinicians′ recognition of this disease.

One boy with Dent-1 disease who was diagnosed by clinical manifestations and gene test at the Guangzhou Women and Children′s Medical Center on November 26, 2015 was selected as the research subject. The clinical data of the patient was collected so as to summarize its clinical characteristics and the process of diagnosis and treatment by retrospectively analysis method. The western literatures related with Dent-1 disease were reviewed from PubMed database and Foreign Medicine Information Resource Retrieval Platform of Shenzhen Maitre Technology Co. Ltd. by the search strategy with " Dent disease" as the subject heading and " Dent′s disease" as the key word. Chinese literatures related with Dent-1 disease were reviewed from Wanfang Data Knowledge Service Platform and China National Knowledge Infrastructure by the search strategy with " Dent disease" as the key word. All literatures were reviewed from October 1997 to December 2017. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

The results of the study on the male patients with Dent-1 disease showed as follows. ①Proteinuria was found by urine routine during physical examination. ②The proteinuria was as high as the diagnostic criteria for nephrotic syndrome without obvious edema, high serum cholesterol and hypoproteinemia. The urinary renal tubular test showed that the level of urine low-molecular-weight protein (LMWP) including urine α1-microglobulin (MG), urine β2-MG, and urine retinol-binding protein (URBP) were obviously increased (more than five times higher than the upper limit of normal reference level) and the urinary protein electrophoresis pointed to LMWP. According to the results of renal biopsy, the patient was misdiagnosed as mild mesangial proliferative glomerulonephritis, and received ineffective treatment of hormones and immunosuppressants. The patient had hypercalciuria, and his urinary system ultrasound and renal functions were normal. ③Genetic test results showed that a c. 2119C>T hemizygote mutation in CLCN5 gene was found in the patient, but this mutation was not found in his mother or sister. He was treated with low oxalate, low sodium, low calcium diet, and drinking lots of water. Besides, the ratio of urinary calcium and urinary creatinine decreased to normal by the treatment of hydrochlorothiazide 1-2 mg/(kg·d) for three months, however it increased after drug withdrawal for one month. The amount of urine protein quantification did not decrease obviously after fosinopril 0.2-0.3 mg/(kg·d) treatment for nine months.

For patients with LWMP urine as the main clinical manifestation and proteinuria which is as high as the diagnostic criteria for nephrotic syndrome, genetic testing should be conducted to confirm whether it is Dent-1 disease or not, avoiding unnecessary invasive and hemorrhagic renal biopsy and a trial of steroid and immunosuppressive treatment. Hypercalcinuria can be controlled by hydrochlorothiazide treatment, and it is necessary to develop a standardized clinical guideline for Dent-1 disease treatment.

To analyze the clinical features of the leucine-rich glioma-inactivated 1 protein (LGI1) antibody related encephalitis in children and review the literature.

From March to November 2016, in Department of Neurology of Children′s Hospital, Capital Institute of Pediatrics, and Beijing Tian Tan Hospital, two cases of LGI1 antibody related encephalitis children (patient 1 and patient 2) were chosen as research objects. Case data of 2 children were analyzed and clinical features of disease were summarized. With the following key words of ＂leucine rich glioma inactivation 1 protein＂ and ＂immunity encephalitis＂ in Chinese, ＂LGI1＂ ＂leucine-rich glioma-inactivated 1 protein＂ and ＂autoimmune diseases of the nervous system＂ in English, literature of anti-LGI1 antibody related encephalitis were searched from WanFang data knowledge service platform, the medical knowledge network, PubMed database, and National Center for Biotechnology Information, literature retrieval time start from the establishment of database to October 2017, and clinical features of searched literature were summarized. This study was consistent with the World Medical Association Declaration of Helsinki revised in 2013.

①Patient 1 was a 8 years old boy, who was the youngest child currently reported to have anti-LGI1 antibody related encephalitis. Chief complaint was ＂night sleep reduced for 50 days＂, the mainly clinical manifestations were night sleep reduced and accompanied by night excitement, no abnormal family history and growth history, no abnormal neurophysical examination. Head MRI showed left hippocampal lesions. Cerebrospinal fluid and serum anti-LGI1 antibody were positive. After treated by intravenous injection of human immunoglobulins (IVIG) and prednisone, the clinical manifestations and head MRI of the child were improved obviously. ②Patient 2 was a 15 years old boy and chief complaint was＂paroxysmal seizures for 7 days＂, the main clinical manifestation was tic, tic form were complex partial seizure and tonic-clonus secondary to partial seizures, not accompanied with memory decline, cognitive disorders, mental disorders, sleep disorders and movement disorders, and serum anti LGI1-IgG antibody positive (1: 100). This child was treated with IVIG and levetiracetam tablets, follow-up for more than 1 year without nerve system and mental symptoms, and with good academic performance. ③ With the retrieval strategy we setting up, literature retrieval results showed that only 3 foreign literature reported anti-LGI1 antibody related encephalitis involving 3 cases of patients of age under 18 years old as 14, 15, 17 years old, respectively. The clinical symptoms of 14 years old anti-LGI1 antibody related encephalitis child were recent memory disorder and mental behavior disorder, who was the youngest child with anti-LGI1 antibody related encephalitis currently reported in public.

The 8-year-old child in this study was the youngest child with anti-LGI1 antibody related encephalitis currently reported at home and abroad. The clinical manifestations of children with anti-LGI1 antibody related encephalitis can be simply onset with sleep disorder or seizure disorder, and head MRI performance has the typical characteristics, the effect of IVIG and glucocorticoid therapy is good.

To summarize the clinical characteristics of 23 cases of children with kala-azar, so as to raise the awareness of clinical physicians to children with kala-azar.

A total of 23 children with kala-azar from March 2005 to April 2017 in West China Second University Hospital, Sichuan University, were selected as study subjects. The clinical manifestations, laboratory test results, treatments and prognosis of 23 cases were retrospectively analyzed, and the clinical characteristics of children with kala-azar were summarized. For the incidences of fever, cough, anemia and other clinical manifestations were expressed by rate (%).

①Among 23 cases of children with kala-azar, the main onset age was 2 to 3 years old, accounted for 56.5% (13/23). The children were mainly distributed in Jiuzhaigou County and Heishui County of Sichuan Province, accounted for 39.1% (9/23). The onset time of kala-azar was scattered throughout the whole year. ②The main clinical symptoms of 23 children with kala-azar were as follows in turn: fever accounted for 100.0% (23/23), cough accounted for 73.9% (17/23), and lack of strength accounted for 65.2% (15/23). The main physical signs of 23 children with kala-azar were as follows in turn: anemia appearance accounted for 69.6% (16/23), splenomegaly accounted for 60.9% (14/23), and lymph node enlargement accounted for 52.2% (12/23). ③Main laboratory test results of 23 children with kala-azar were as follows: pancytopenia accounted for 85.7% (18/23), abnormal liver function accounted for 30.4% (7/23), blood coagulation dysfunction accounted for 8.7% (2/23), lit-duchenne body founded in bone marrow smear accounted for 90.9% (20/22), and rk39 immunochromatographic strip test showed positive accounted for 80.0%(16/20). ④The main treatment of 23 children with kala-azar was antimony intramuscular injection or intravenously guttae, and all 18 children treated in our hospital were healed and discharged from hospital without recurrence.

For children with fever, anemia and hepatosplenomegaly, early perfection of bone marrow biopsy smears and serum antibody examination are keys to reduce the missed diagnosis and misdiagnosis of children with kala-azar. And standardized treatment is beneficial to improve the prognosis of children with kala-azar.

To study the clinical characteristics of children with hand, foot and mouth disease (HFMD) in Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region.

A total of 45 793 children with HFMD in Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 1, 2013 to December 31, 2016, were selected as research subjects. After obtaining informed consents of all cases, throat swabs or (and) herpes fluid samples were collected from 363 mild type of HFMD cases, and throat swabs samples from 732 severe type of HFMD cases to detect enterovirus (EV) including EV71, coxsackievirus (Cox)A16 and other types of EV. Clinical data of all children with HFMD were analyzed retrospectively, and the characteristics of HFMD cases in our hospital from 2013 to 2016 were analyzed statistically including: ①rates of severe type and fatality rates of HFMD in each year; ②distribution characteristics of HFMD including months, ages, gender, crowd and region, and rates of severe type of HFMD of these factors; ③etiologic characteristics of HFMD cases. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region.

①Among 45 793 HFMD children, 98.40% (45 061/45 793) of them were with mild type of HFMD, and 1.60%(732/45 793) were with severe type of HFMD. Fatality rate of children with severe type of HFMD was 1.64%(12/732). In 2013, rate of severe type of HFMD (1.13%) was the lowest compared to that of 2014 (1.85%), 2015 (1.69%) and 2016 (1.65%), respectively, and all the differences were statistically significant (P<0.05). Fatality rate of children with HFMD in 2014 (0.06%) was higher than that of 2013 (0.01%) and 2015 (0), respectively, and all the differences were statistically significant (P<0.05). ②Constituent ratio of HFMD monthly incidence: the most cases occurred in September in 2013 and 2015 with proportion of 30.90% and 26.43%, respectively, while the most cases occurred in May in 2014 and 2016 with proportion of 28.59% and 31.47%, respectively. The highest rate of severe type of HFMD every month in each year were 2.15% in April 2013, 5.34% in February 2014, 6.48% in March 2015 and 5.50% in October 2016, respectively. ③For age distribution characteristics: the largest proportion was 57.47% in age of children >1-3 years old. 94.96% of HFMD cases were age of children ≤5 years old.Rates of severe type of HFMD in children ≤1 year old or >1-3 years old were higher than those of children >3-5 years old and >5 years old, respectively, and all the differences were statistically significant (P<0.05). ④The proportion of male children with HFMD was 61.47% (28 149/45 793). Rate of male with severe type of HFMD (1.80%, 508/28 149) was higher than that of female (1.27%, 224/17 644), and the difference was statistically significant (χ²=19.745, P<0.001). HFMD proportion of scattered children, children in kindergarten and students were 73.11%, 25.56% and 1.33%, respectively, and rates of severe type of HFMD were 1.92%, 0.67% and 1.97%, respectively. HFMD constituent ratio of living in Nanning city, other counties in Nanning and other districts outside Nanning were 91.48%, 8.31% and 0.21%, respectively, and rates of severe type of HFMD children were 1.09%, 7.25% and 1.03%, respectively. ⑤EV positive rate of mild type of HFMD cases (87.05%, 316/363) was higher than that of severe type of HFMD cases (78.28%, 573/732), and the difference was statistically significant (χ²=12.272, P<0.001). The preponderant EV from mild type of HFMD cases were CoxA16 in 2013, EV71 in 2017, other types of EV in 2015 and CoxA16 in 2016, and the preponderant EV from severe type of HFMD cases were other types of EV in 2013, EV71 in 2014, other types of EV in 2015 and other types of EV in 2016. There were 12 death cases, and 83.34% (10/12) of them were tested positive of EV71.

From 2013 to 2016 in our hospital, the most HFMD cases occurred annually from April to June, or from August to October, boys were more affected of HFMD than that of girls, and high risk populations were in scattered children≤ 5 years old in Nanning city. The mild type of HFMD cases were mainly caused by Cox A16, and the severe type of HFMD cases were mainly caused by other types of EV.

To study the clinical characteristics, treatment strategies and outcomes of very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI), and to provide references for the treatment of them.

From of 1 January 2009 to 31 December 2015, a total of 1 146 cases of VLBWI/ELBWI who were hospitalized in Department of Neonatology, West China Second University Hospital, Sichuan University were recruited as research subjects. According to the gestational ages, the VLBWI/ELBWI were divided into 4 groups: <28 weeks group (n=84), and ≥28-32 weeks group (n=679), ≥32-37 weeks group (n=378), ≥37 weeks group (n=5). The clinical characteristics of each group were analyzed, and hospitalization time, survival rate, rate of using ventilator, rate of the main complications, and the situation of giving up treatment were statistically compared among groups.

Among 1 146 cases of VLBWI/ELBWI, there were 1 141 premature infants and 5 full-term infants. Because the number of full-term infants was too small, they were not analyzed by statistical methods, <28 weeks, ≥28-32 weeks, ≥32-37 weeks group were compared by related statistical methods. The results showed as follows. ①There were significant differences among 3 groups in hospitalization time and survival rate (Z=34.667, P<0.001; χ²=71.012, P<0.001). And the smaller of gestational age, the longer of hospitalization time, the lower of survival rate among those 3 groups. ②Rates of using invasive ventilation in <28 weeks group were higher than those in ≥28-32 weeks group and ≥32-37 weeks group, and both the differences were statistically significant (χ²=53.001, 162.157; P<0.001). Rate of using noninvasive assisted ventilation in <28 weeks group and ≥28-32 weeks group were higher than those in ≥32-37 weeks group, and both the differences were statistically significant (χ²=21.872, 74.418; P<0.001), but there was no significant difference between <28 weeks group and ≥28-32 weeks group in the rates of using noninvasive assisted ventilation (P>0.05). There were significant differences in durations of noninvasive assisted ventilation treatment among 3 groups by pairwise comparison (Z=-4.077, P<0.001; Z=-4.655, P<0.001; Z=-2.879, P=0.002), and the smaller of gestational age, the longer duration of noninvasive assisted ventilation treatment. ③There were significant differences among common complications, such as neonatal respiratory distress syndrome (NRDS), severe intracranial hemorrhage (Ⅲ-Ⅳ), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) in 3 groups (χ²=111.662, 74.639, 58.076, 70.049; P<0.001), and the smaller gestational age, the higher incidences of aboved complications among 3 groups. There were significant differences in the incidences of apnea and intrauterine infection in 3 groups (χ²=59.683, P<0.001; χ²=25.937, P<0.001), and the incidences of apnea and intrauterine infection in <28 weeks group and ≥28-32 weeks group were higher than those in ≥32-37 weeks group, and all the differences were statistically significant (χ²=19.586, 57.893, P<0.001; χ²=10.146, 25.019, P<0.001), but there were no significant differences between <28 weeks group and ≥28-32 weeks group in the incidences of apnea or intrauterine infection (P>0.05). ④There were significant difference in 3 groups of rates of abandoned treatment (χ²=18.636, P<0.01). The smaller gestational age, the higher rate of abandoned treatment among 3 groups. Among the dead of VLBWI/ELBWI, the percentage of death after abandoned treatment was 73.8% (141/191).

In the VLBWI/ELBWI, the smaller gestational age, the higher rate of complications, higher use rates and longer use time of ventilations, and the lower survival rate. Reducing the proportion of abandoned treatment can improve the survival rate of VLBWI/ELBWI.

To investigate the significance of neonatal critical illness score (NCIS)(Draft) for treating critically ill neonates.

A total of 581 cases of critically ill neonates who were treated in Department of Neonatology, Bazhong Central Hospital of Sichuan Province from May 2012 to May 2015 were selected as research subjects. All the 581 cases met the neonatal critical cases diagnostic criteria in NCIS (Draft) and their clinical data were collected by retrospective method. The single index that matched the index of critically ill neonates of NCIS (Draft) and the score points of inspection items of NCIS for critically ill neonates whose NCIS score ≤90 points were statistically analyzed. According to the prognosis of the 581 cases, they were enrolled into good prognosis group (n=445), and poor prognosis group (n=136). The clinical data between two groups were statistically analyzed. Combined with the results of existing researches and clinical practice, some factors were introduced into multivariate unconditional logistic regression analysis to analyzed the prognostic factors of critically ill neonates.

①Among the 581 cases of critically ill neonates, the number of male neonates was higher than female neonates (370∶211). Most neonates were born in 1 d (420 cases, 72.3%), and there were more neonates via cesarean section than those via vaginal delivery (337∶244). And 54.7% (318/581) neonates had at least one high risk factor. The first three diseases of critically ill neonates were neonatal respiratory distress syndrome (NRDS) (32.4%, 188/581), neonatal pneumonia (22.7%, 132/581), and neonatal asphyxia (15.8%, 92/581). ②Among the 581 cases of critically ill neonates, 455 cases (78.3%) were diagnosed as neonatal critical cases by single index of NCIS (Draft), which were mostly presented as requiring tracheal intubation or repeating apnea without response to stimulation (59.3%, 270/455), severe hyper bilirubinemia (16.7%, 76/455), and hypoglycemia (10.1%, 46/455). Among the 581 cases of critically ill neonates, 585 cases (96.0%) were diagnosed as neonatal critical cases by NCIS score ≤ 90 points. And the first three inspection items with most easily deducted were pH value ≤7.25 or ≥7.50 (31.5%, 176/558), respiratory rate ≤ 25 time/min or ≥ 60 time/min (18.1%, 101/558), and partial pressure of oxygen in artery (PaO₂) ≤ 60 mmHg (1 mmHg=0.133 kPa) (16.8%, 94/558). ③There were no statistical differences between good prognosis group and poor prognosis group in the gender ratio, onset age, and gestational age (P>0.05). Compared with poor prognosis group, the birth weight in good prognosis group was heavier, the hospitalization time was longer, cesarean delivery rate was higher, but the proportion of very critical newborns (NCIS score< 70 points) in good prognosis group was lower, and all the differences were statistically significant (P<0.05). ④The results of multivariate unconditional logistic regression analysis indicated that birth weight, hospitalization time and NCIS score were independent factors affecting the prognosis of critically ill newborns (OR=2.528, 95%CI: 1.178-5.426, P=0.017; OR=76.736, 95%CI: 27.279-215.858, P<0.001; OR=106.697, 95%CI: 43.952-259.019, P<0.001).

The single index and NCIS score in NCIS (Draft) can reflect the state of neonatal lesions accurately and effectively. So this method can guide the treatment and prognosis assessment of critically ill newborns and is beneficial for building referral mechanism in primary hospital and emergency access for critical neonates. Thus it can improve the rate of successful rescue and reduce the mortality rate of critically ill neonates.

Precision medicine is the inevitable trend of modern medical advance. Its basic principle is to find the molecular pathogenesis of the diseases, after then to look for targeted biomarkers in order to make the targeted therapy. In the article, taking X-linked agammaglobulinemia (XLA), one of the primary immunodeficiency diseases (PID) as an example, to illustrate that the diagnosis and treatment process of PID is based on the basic principle of precision medicine. The PID is a kind of heterogeneous diseases with very complex and diversity clinical phenotypes involving various clinical specialists. This article notes that both general and special pediatricians should not only to understand the clinical manifestations of the PID, but also do further genetic analysis and molecular biological mechanism studies. If so, clinical management of PID will be in accordance with the principle of precision medicine.

To explore the impact of oligohydramnios on delivery outcomes of full-term pregnant women and perineonates.

A total of 287 cases of full-term pregnant women with oligohydramnios(oligohydramnios group) in the First Affiliated Hospital of Third Military Medical University from January 2013 to December 2014 were selected as study objects, and a total of 300 cases of normal full-term pregnant women in the same period were randomly selected and bringing into control group.The differences of incidence rate of fetal anomaly, prolonged pregnancy, fetal growth restriction(FGR), hypertensive disorders in pregnancy and the cesarean section between two groups, and perineonate outcomes between two delivery ways in each group were compared statistically.

① The incidence rate of fetal anomaly, prolonged pregnancy, FGR and hypertensive disorders in pregnancy, and the cesarean section rate in oligohydramnios group were all higher than those of control group, and the differences were statistically significant(1.7% vs 0.3%, χ²=2.83, P<0.01; 13.2% vs 3.0%, χ²=20.88, P<0.05; 3.8% vs 0.6%, χ²=6.70, P<0.01; 7.0% vs 1.6%, χ²=10.11, P<0.05; 82.9% vs 30.7%, χ²=162.76, P<0.01). ② In oligohydramnios group, the average weight of newborns, incidence rate of fetal distress, aspiration pneumonitis of newborns and neonatal asphyxia were all higher in pregnancy with vaginal delivery than those in pregnancy with cesarean section delivery, and the differences were statistically significant [(3 308±346) g vs (3 194±373) g, t=2.03, P<0.05; 36.7% vs 18.1%, χ²=8.46, P<0.05; 32.6% vs 17.6%, χ²=5.52, P<0.01; 30.6% vs 15.6%, χ²=6.22, P<0.01].

For full-term pregnancy with oligohydramnios patients, the risk of vaginal delivery is higher than normal amniotic fluid patients.So, strengthen prenatal care and regular prenatal examination may be good to improve delivery outcome.

To further the understanding of the clinical features and molecular genetics of X-linked thrombocytopenia(XLT), facilitating early diagnosis.

From January 2012 to May 2014, three children with XLT were included in the study.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University. Informed consent was obtained from each participants' parents.The clinical data and genotypes of the three cases of XLT who were diagnosed by WAS gene analysis were analyzed respectively.

The 3 cases (100.0%) with XLT were all boys characterized clinically by chronic or intermittent thrombocytopenia, without positive family history.Before definite diagnosis of XLT via WAS gene mutation analysis, all 3 cases were misdiagnosed as primary immune thrombocytopenia(ITP) and were given steroid and intravenous immunoglobulin (IVIG) therapies, but resulting in persistent or intermittent thrombocytopenia. WAS gene mutation analysis revealed 2 types of missense mutation, c. 1378C>T located in extron 11 of case 1 and 3, while c. 256C>T located in extron 2 of case 2. The mothers harbored the same respective WAS gene mutations.

XLT, a mild form of WAS, caused by WAS gene mutations, is clinically characterized by chronic or intermittent microthrombocytopenia and is easily be misdiagnosed as ITP. With high clinical alertness of XLT, pediatricians should always considering the diagnostic possibility of XLT when faced with boys presenting with thrombocytopenia during infancy and toddler period, particularly with poor therapeutic responses to conventional steroid or IVIG therapy. Early diagnosis could possibly be made based on elaborate history-taking, dynamic monitoring of platelet count and mean platelet volume (MPV), WAS gene mutation analysis which is of great importance for the clinical management and prediction of prognosis.

To investigate the clinic features of postpartum hemolytic uremic syndrome (PHUS) for early diagnosis, prompt therapy and better prognosis.

A retrospective study was conducted on clinical data of 6 PHUS patients with gestational age over 33 weeks in Suzhou Hospital Affiliated to Nanjing Medical University from January 2008 to December 2012. Clinical symptoms and signs, hemolytic uremic related indexes, ultrasonograph and peripheral blood smear of them were analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Suzhou Hospital Affiliated to Nanjing Medical University.

All 6 patients had pregnancy combined with severe preeclampsia. After antispasmodic, antihypertensive treatment and promot fetal lung mature, they gave birth by cesarean section, and no neonatal death. The main symptoms were gradually oliguria and anuria without remote cause, hemolytic anemia, thrombocytopenia and sharp decline of renal function after 1-2 days of cesarean section. Through comprehensive treatment based on continuous renal replacement therapy (CRRT) and plasma exchange, the patient's conditions were stable and improved, and all patients were discharged from hospital. After 1 year follow up, 3 cases(50.0%) were lost to follow up, l case (16.7%) with chronic renal insufficiency.

Preeclampsia is one of the important remote causes of PHUS. It's necessary to strengthen renal function monitoring of pregnant women with preeclampsia after childbirth, in order to make early diagnosis and give specialized treatment in time, which are significant measures to reduce maternal mortality and ensure mother's healthy.