教化使命、同情心、自我保護論英國女作家立德的中國遊記與旅遊倫理

Objective To study the clinical manifestations, treatment and hospitalized outcomes of neonatal purulent meningitis. Methods This was a prospective observational study with institutional ethics approval of West China Second University Hospital, Sichuan University and written consent from the parents of each participating neonate. From January 2008 to December 2012, a total of 52 neonates with neonatal purulent meningitis in West China Second University Hospital, Sichuan University were recruited. Their clinical manifestations, lab examination results, head image results, and prognoses were analyzed respectively. Results The most frequently signs were low response(61.54%,32/ 52) and fever(57.69%, 30/ 52) , the incidence of nerver system abnormal signs such as abnormal muscle tone(51.92%,27/ 52) , seizure(28.85%,15/ 52) , bulging fontanel(19.23%,10/ 52) and positive meningeal irritation sign(3.85%,2/52) was low among 52 neonates with neonatal purulent meningitis．The positive incidence of the first result of lab test including infection markers in blood and cerebrospinal fluid (CSF) was low also．There had significance difference between blood white blood cell (WBC) and C-reacting protein(CRP) (63.50% vs． 38.46%, P<0.05) , and between WBC and protein amount in CSF (67.31% vs． 38.46%, P<0.01) , respectively．The pathogenic bacteria raised from blood and CSF, Gram-negative(G-) bacteria were more than Gram-positive (G+) , the Escherichia coli took the first place (26.92%, 7/ 26) ; All bacteria were conditional pathogenic bacteria, most of these were multiple resistant bacteria (69.23%, 18/ 26) ．Every patient received at least two antibiotics, the 3rd generation cephalosporin were the most popular(82.69%, 43/ 52) , following meropenem (38.46%,20/ 52) , there were 3 cases used vancomycin and cefepime (4th generation cephalosporin) respectively. Conclusions To discriminate neonatal purulent meningitis early, we need a constant surveillance for neonatal having high risk factors of meningitis and serial CSF examing. Most pathogens were multiple resistant bacteria. It is hard to be cured, and the prognoses are poor. Key words: Meningitis, bacterial; Infant, newborn; Anti-bacterial agents

Objective To study MRI and clinical manifestation of posterior cranial fossa tumors in children, in order to improve the recognition of clinical and decrease the misdiagnosis rates on posterior cranial fossa tumors in children. Methods From February 2014 to April 2015, a total of 8 cases of children with posterior cranial fossa tumors in West China Second University Hospital, Sichuan University who diagnosed by postoperative pathological examination were enrolled in the study. MRI examination method to posterior cranial fossa tumors in children: craniocerebral scanning was performed by 1.5T MRI in all 8 cases of patients. MRI conventional scanning included T1WI, T2WI, T2W-flair and sagittal T1WI. Gadolinium (Gd) contrast enhanced T1WI was performed in 4 cases. MRI and clinical characteristics were retrospectively analyzed. The value of MRI in diagnosis and treatment of children with posterior cranial fossa tumors were evaluated. The causes of clinical misdiagnosis of were analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University. Results According to the criteria of pathological classifications of posterior cranial fossa tumors, 8 cases of posterior cranial fossa tumors were divided into medulloblastoma (2 cases), cerebellar hair cell astrocytoma (1 case), brain stem encephalitis (3 cases), ependymoma (1 case) and anaplastic ependymoma (1 case). The clinical manifestations of the 8 patients were non-specific, which were dyskinesia, headache, vomiting, cough and etc.. The common MRI features were tumors in the posterio cranial fossa which involved in brain stem, fourth ventricle and cerebellum. The specific clinical manifestations and MRI features of different pathological classifications of posterior cranial fossa tumors were as follows. ①Medulloblastoma (2 cases) was with dyskinesia, facial paralysis, and solid masses in the vermis cerebelli. ②Cerebellar hair cell astrocytoma (1 case) was with dyskinesia, gait abnormal, and obvious enhancement nodule in the cerebellar. ③Brain stem encephalitis (3 case) was with instability of gait, dysdipsia, dysphonia, and masses in the brain stem enhanced lightly. ④Ependymoma (2 case) was without specific clinical features and with tumor in the forth ventricle grew through the lateral aperture and with metastasis by cerebrospinal fluid. Among 8 cases, 3 cases were clinically misdiagnosed, 2 cases were brain stem encephalitis and 1 case was anaplastic ependymomas. The reasons of clinical misdiagnosis were the nonspecific signs and symptoms, and the delayed cranial MRI examination. Conclusions There were some significant MRI features in posterior fossa tumors in children. Early application of MRI and acquaintance with the clinical manifestations can reduce the clinical misdiagnosis rate. MRI is of great significance in diagnosis and differential diagnosis of posterior cranial fossa tumors in children. Key words: Infratentorial neoplasms; Diagnostic errors; Clinical feature; Magnetic resonance imaging; Child

Objective To evaluate clinical effects of blood purification in the treatment of children with multiple organ dysfunction syndrome (MODS). Methods A total of 194 cases with MODS who were admitted to West China Second University Hospital, Sichuan University from January 2007 to July 2011 were retrospectively reviewed. According to different treatment regimen, they were divided into treatment group (n=96, basic treatment+ blood purification) and control group (n=98, only basic treatment). Compare the following parameters between two groups: gender constituent ratio, age, basic diseases, pediatric logistic organ dysfunction (PELOD) score, mortality, hospitalization and results of major biochemical tests [serum creatinine, blood urea nitrogen, aspartate aminotransferase (AST), cardiac troponin(cTn)I, Na+ , K+ , partial pressure of oxygen in artery (PaO2) / fraction of inspired oxygen (FiO2)] before and after the treatment. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University. Results ① There were no significant difference between two groups in the aspects of gender constituent ratio (χ2=0.495, P=0.482), but there were significant differences in age, PELOD score of impaired organs (χ2=54.069, P=0.000, Z=-1.291, P=0.197). ②The mortality of treatment group was significantly lower than that in control group (20.8% vs 42.9%)(χ2=10.56, P=0.002). There was no significant difference between two groups in hospitalization (Z=-1.203, P=0.229). And duration from admission to death was 8.0 days in treatment group and 17.0 days in control group with significant difference (Z=-2.007, P=0.045). ③ There were significant differences between two groups in the aspects of levels of creatinine, BUN, and Na+ after the treatment (Z=-2.325, -2.498, -3.179; P 0.05). Conclusions Blood purification could decrease the mortality of children with MODS significantly and improve their renal function. Key words: Blood purification; Multiple organ dysfunction syndrome; Child

Objective To investigate the clinical manifestations and laboratory examination results of the neonatal hyperbilirubinemia caused by glucose-6-phosphate dehydrogenase (G-6-PD) deficiency combine with ABO blood group incompatibility hemolysis to the G-6-PD deficiency or the ABO blood group incompatibility hemolysis. Methods A total of 643 cases of full-term newborn infant which were treated and diagnosed as neonatal G-6-PD deficiency and ABO blood group incompatibility hemolysis hospitalized in West China Second University Hospital, Sichuan University from January 2008 to December 2012 were chosen as study subjects.According to the types of diseases, they were divided into 3 groups: group A (n=20, G-6-PD deficiency combine with ABO blood group incompatibility hemolysis group), group B (n=52, G-6-PD deficiency group), group C (n=571, ABO blood group incompatibility hemolysis group). The clinical manifestations and laboratory results were analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of West China Second University Hospital, Sichuan University.Informed consent was obtained from the parents of each participating patient. There were no significant differences about birth weight, gestation age and modes of delivery among three groups(P>0.05). Results The study results were: ① Gender constituent ratio and jaundice incidence within 24 h after birth of group A compared with group B, the differences were statistically significant(χ2=9.010, 9.013; P=0.003, 0.003); but compared with group C, there were no statistically significant difference(χ2=1.670, 1.408; P=0.196, 0.235). ②The hospitalized age and the time point of visible jaundice of group A compared with group B, the differences were statistically significant(P<0.001, P=0.017); but compared with group C, there were no statistically significant difference(P=0.805, 0.074). ③ Peak amplitude of serum bilirubin level and the incidence rate of acute bilirubin encephalopathy of group A compared with group B, there were no statistically significant difference(P=0.108; χ2=0.633, P=0.426); and compared with group C, there were no statistically significant difference, too(P=0.837; χ2=0.000, P=1.000). Conclusions The time point of visible jaundice of the neonatal G-6-PD deficiency overlap with the physiologic jaundices, it will delay to see the doctor and cause critical hyperbilirubinemia and acute bilirubin encephalopathy; but, when combine with ABO blood group incompatibility hemolysis, the time point of visible jaundice would ahead of schedule and get early treatment to reduce critical complication. Key words: Glucosephosphate dehydrogenase deficiency; ABO blood-group system; Hyperbilirubinemia; Infant, newborn

Since Communist China came to power, it has upheld Marxist-Leninist Communism as its top guiding policy and wrecked havoc on Chinese traditional culture, most especially during China's Cultural Revolution, when ”Confucius-bashing” aimed to totally eradicate Confucian philosophy and values. Today, China has turned around to keenly promote Chinese language and cultural studies internationally by establishing ”Confucius Institutes” extensively in many countries. Since the inception of the first Confucius Institute in Seoul, Korea on November 21, 2004, and up till March 2008, China has already set up 238 such institutes. Set up through China's cooperation with local organizations, these non-profit educational institutes were mostly initiated, and agreements signed, during state visits by foreign leaders to China; or during top Chinese officials' visits to other countries, for ground-breaking or opening ceremonies of these institutes. It is worthwhile to study and analyze what China's objectives and motivation are behind its high-profile establishment of Confucius Institutes overseas. Rapid advancement in transportation and communication technologies has allowed ever more frequent cross-cultural engagement and communication among countries by different people on various issues and topics. This is the so-called ”Intercultural Communication” in journalistic terminology. If viewed from this perspective, the establishment of Confucius Institutes for promoting Chinese language studies and Chinese culture is actually an attempt for engagement in cross-cultural communication. This study uses relevant theories as basis and analytical rationalization to clarify terminologies and principles regarding intercultural communication as these relate to the reasons for China's establishment of Confucius Institutes overseas; then use the current status and progress of these institutes as evidence and explanation; and finally, analyze China's objective and anticipated results for establishing Confucius Institutes as a conclusion.

Objective To investigate the expression of glucose transporter (GLUT1), phosphoglycerate kinase(PGK1) and lactate dehydrogenase (LDHA) in placentas of women with intrahepatic cholestasis of pregnancy (ICP). Methods From June to October, 2014, a total of 20 samples of placentas from women with ICP were included as the study group, and another 20 samples of normal placentas were selected as control group according to random number table. The relative expression levels of GLUT1 mRNA, PGK1 mRNA and LDHA mRNA were measured by real-time polymerase chain reaction (RT-PCR), and the relative protein levels of GLUT1, PGK1, LDHA were detected by Western blotting assay and immunohistological analysis. There were no significant differences between two groups in age, gestational age, gravidity, parity, birth weight of newborns and placental weight (P>0.05). 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 the parents of each participating patients. Results ① There were no statistically significant difference between two groups in the relative expression levels of GLUT1 mRNA, PGK1 mRNA and LDHA mRNA (P>0.05). ② The relative protein levels of GLUT1, PGK1 and LDHA in control group were statistically lower than those in ICP group, which with significant difference (t=3.270, P=0.003; t=4.222, P<0.001; t=3.585, P=0.002). ③ All the proteins including GLUT1, PGK1 and LDHA were detected in the cytoplasma of cytotrophoblast and syncytiotrophoblast. Conclusions Under hypoxic conditions in pregnant women with ICP, the increased level of glycolysis may play a role in negative pregnancy outcomes. Key words: Pregnancy; Cholestasis, intrahepatic; Anoxia; Glycolysis; Pregnant women

Objective To study weight gain characteristics of gestational diabetes mellitus (GDM) and normal pregnant women during perinatal period. Methods From March 2013 to April 2014, a total of 719 cases of pregnant women who took prenatal check-up as out-patient in department of nutrition or department of obstetrics, and carried out the follow-up in Sichuan Provincial Hospital for Women and Children, West China Second University Hospital of Sichuan University, and Chengdu Women and Children′s Central Hospital were selected as research subjects. The data were built on the basis of 1-year-long longitudinal study on 719 cases of pregnant women, among which 124 cases were GDM (divided into GDM group) and 595 were normal pregnant women (divided into control group). The observations were focused on the weight gains among these two groups of pregnant women in varied ages and pre-pregnancy body mass index (BMI). Results In the second, third trimester and throughout whole pregnancy of GDM group, weight gains were lower than those of control group, which were (8.6±3.1) kg vs (9.5±3.0) kg, (4.5±3.0) kg vs (6.4±2.4) kg, and (14.3±3.0) kg vs (16.6±4.5) kg, respectively, and all the differences were statistically significant (t=2.910, P=0.004; t=7.470, P<0.001; t=5.340, P<0.001). In the first trimester pregnancy of GDM group, weight gain was higher than that in control group, which was (1.25±2.23) kg vs (0.74±2.51) kg, and there was significant difference between two groups (t=-2.101, P=0.036). In GDM group, BMI value during pre-pregnancy of pregnancy women whose ages ≥35-year-old was higher than that of ages <35-year-old, while the weight gains during the second and throughout whole pregnancy of pregnant women whose ages≥35-year-old were lower than those of ages<35-year-old and all the differences were statistically significant (t=-2.212, P=0.029; t=2.052, P=0.042; t=2.081, P=0.040). Among ages ≥35-year-old pregnant women, whose BMI value in GDM group was higher than that in control group, but weight gain was lower than that in control group, there were significant differences between two groups (t=-2.715, P=0.009; t=2.732, P=0.008). At postpartum 3 d and 42 d in GDM group, the body weights among pregnancy women with BMI value <18.5 kg/m2, ≥18.5-24.0 kg/m2, and BMI≥24.0 kg/m2, there were significant differences (F=30.357, 24.378; P<0.001), and their body weights increased along with the increasing of their pre-pregnancy BMI values. Conclusions It is suggested to take recommended perinatal weight standard as a regular index for GDM. To scientifically prevent and treat GDM, especially the elderly and overweight pre-pregnancy BMI pregnant women. Key words: Diabetes, gestational; Mean weigh; Weight gain; Perinatal; Pregnant women

Objective 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. Methods 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 (%). Results 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. Conclusions 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. Key words: Leishmaniasis, visceral; Leishmania donovani; Parasitic diseases; Child

Objective To analyze the anesthesia characteristics of Ya'an Lushan-earthquake (YLE) and Wenchuanearthquake (WCE) victims and provide experience for future medical care during disaster rescue.Methods Collecting related anesthesia information from medical records of surgeries performed for the victims during the two earthquake periods in West China Hospital,Sichuan University.The categories of surgery and anesthesia,patients' condition,intraoperative and postoperative complications were compared.Results Two hundred and twenty five surgeries during YLE and 875 surgeries during WCE were performed in West China Hospital.The main category of surgeries was open reduction and internal fixation (YLE 65.3％,WCE 41.7％).More amputations were carried out in WCE(11.8％ vs 1.8％).The victims classified in ASA Ⅰ in YLE were fewer than those in WCE (4.4％ vs 23.2％),while patients with the ASA Ⅳ were more in YLE (8.0％ vs 1.4％).The main anesthesia method was general anesthesia during both earthquakes (YLE 92.9％,WCE 70.5％).Epidural anesthesia was performed less in YLE (0.8％ vs 13.2％).The most common intraoperative complications were hypotension(YLE n=28,WCE n=73),hypoxemia (YLE n=1,WCE n=42) and aspiration (YLE n=0,WCE n=13).Conclusions The main category of surgeries for earthquake victims was orthopedics.Most surgeries were performed under general anesthesia.The earthquake victims were commonly followed by a variety of serious complications.Hypotension,hypoxemia and aspiration should be avoided during the rescue. Key words: Ya'an Lushan-earthquake; Wenchuan-earthquake; Anesthesia

Objective To explore the ultrasonic manifestations of primary female genital system lymphoma (PFGSL), and to provide guidance for the ultrasonic diagnosis of this disease. Methods A total of 15 patients with PFGSL who underwent surgical treatment in West China Second University Hospital, Sichuan University from September 1, 2008 to July 31, 2016 and were finally diagnosed as PFGSL by postoperative histopathological examination were selected as the study subjects by retrospective analysis method. All the 15 patients received preoperative ultrasound examinations. The clinical manifestations, preoperative ultrasonography results and postoperative histopathological examination results of those 15 patients were analyzed. The count data, such as proportions of different types of lesions were expressed by rate (%). This study was in line with the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Results The analysis results of those 15 patients were as follows. ①Clinical manifestations: the main clinical manifestations of 10 cases of patients with primary ovarian lymphoma were pelvic mass or ascites. Three cases of patients with primary cervical lymphoma and one case of primary endometrial lymphoma were mainly characterized by irregular vaginal bleeding. One case of patient with primary vaginal lymphoma was mainly characterized by perineal discomfort and irregular vaginal bleeding. ②Preoperative ultrasonography results: one patient with primary vaginal lymphoma failed to find space-occupying lesions, and the other 14 patients all found lesions. A total of 20 lesions were detected, including 16 lesions, 3 lesions and 1 lesion in patients with primary ovarian, cervical and endometrial lymphoma, respectively. Ultrasound examinations of patients with primary ovarian lymphoma showed peritoneal thickening and metastatic nodules. And the features of ultrasound sonogram of metastatic nodules and primary tumors were close, all of which were solid weak echoes with abundant blood flow signals. And 62.5% (10/16) lesions in patients with primary ovarian lymphoma had cystic changes, and their blood flow signals were sparser compared to solid lesions. Ultrasound examination of patients with primary cervical and endometrial lymphoma showed slightly weak echoes in the uterus with relatively abundant blood flow signals. ③Postoperative histopathological examination results: all those 15 subjects were finally diagnosed as PFGSL, belonging to non-Hodgkin lymphoma (NHL), including 13 cases of B-cell NHL and 2 cases of T-cell NHL (all of them were primary ovarian lymphoma). ④Surgical results: 21 lesions were removed, of which 57.1% (12/21) were gray white and fishy solid masses, and 42.9% (9/21) lesions were associated with cystic changes. Conclusions The clinical and ultrasonic manifestations of PFGSL are related to the invasion site of PFGSL, and B-cell-derived tumors account for the majority of PFGSL. The ultrasound images of PFGSL have certain characteristics and may provide a reference for the diagnosis and treatment of the disease. Key words: Genital neoplasms, female; Lymphoma; Ultrasonography; Lymphoma, non-Hodgkin; Diagnosis, differential; Female

Objective To elevate the prevalence of fusion gene in children with acute lymphoblastic leukemia(ALL), and compare the difference in the clinical characteristics and prognosis of children with ALL carrying different fusion genes. Methods The results of fusion gene that detected by multiplex RT-PCR in children with 341 newly diagnosed ALL between July 2013 and December 2016 in West China Second University Hospital, Sichuan university were retrospectively reviewed. Date of clinical characteristics, morphology, immunophenotype, cytogenetic characteristics and event-free survival were collected and analyzed by χ2 test and survival analysis in different groups according the results of fusion genes. Results The positive rate of fusion genes was 35.2%(120/341), including 69 cases with TEL-AML1, 16 cases with E2A-PBX1, 16 cases with BCR-ABL, 10 cases with MLL gene rearrangement, 5 cases with HOX11L2 and 4 cases with SIL-TAL1. There was statistical difference in age of different fusion gene groups(χ2=29.552, P 0.05). Conclusions Fusion gene detection is an important molecular marker in ALL of children. The ALL children with different fusion genes have different clinical features, immunophenotype and prognosis.(Chin J Lab Med, 2018, 41: 190-195) Key words: Acute lymphoblastic leukemia; Children; Fusion gene; Clinical characteristic; Prognosis

Objective To investigate the incidence of hyperbilirubinemia in late preterm newborns and their perinatal management. Methods From October 2013 to March 2015, a total of 35 cases of late preterm newborns who were diagnosed as hyperbilirubinemia were selected from 276 inpatient of late preterm newborns in Department of Neonatology, West China Second University Hospital, Sichuan University were included in study group, and another 35 patients who had not been diagnosed as hyperbilirubinemia were selected randomly from the other 241 inpatient cases and were included in control group by isometric sampling method. Retrospective analysis method was used to collect the clinical data of two groups and to analyze the following items. ①To compare the constituent ratios of gender, gestational age at birth, day age at the time of admission, admission ways, appropriate for gestational age (AGA) infants, small for gestational age (SGA) infants, large for gestational age (LGA) infants, delivery modes, and the incidences of premature rupture of membrane, intrauterine or postnatal asphyxia, cephalohematoma, pregnancy diseases in pregnant women between study group and control group by chi-square method or Fisher exact probability method. ②Incidence of hyperbilirubinemia among 276 cases of late preterm newborns in the study, and the relationship with the gender were analyzed. ③The constituent ratios of gender, day age at the time of admission, admission ways, gestational age at birth, AGA or LGA infants, delivery modes, birth institutions, and the incidences of severe and extremely severe highperbilirubinemia, concomitant diseases or causes of disease, bilirubin encephalopathy and readmission etc. in study group were analyzed. Results ①There were significant differences between two groups among the constituent ratios of gestational age at birth, day age at the time of admission, admission ways, premature types, delivery modes, and the incidences of premature rupture of membranes and intrauterine or postnatal asphyxia (χ2=12.011, P=0.002; χ2=16.931, P 0.05), respectively. ②Among the 276 cases of late preterm newborns included in the study, hyperbilirubinemia incidence was 12.7% (35/276). Gender ratio of male and female was 1.9∶1 in 35 cases of late preterm newborns diagnosed as hyperbilirubinemia. ③Among the 35 hyperbilirubinemia of late preterm newborns in study group, the gestational age at birth was 34+ 0-36+ 6 weeks, severe and extremely severe hyperbilirubinemia both were 15 cases, which accounting for 85.7% (30/35), there was none of dangerous hyperbilirubinemia neonates. And hyperbilirubinemia of late preterm newborns whose age≤7 d was more than that of age>7 d at the time of admission, and the proportion of late preterm newborns of age≤7 d was 60.0% (21/35), after discharge from rooming-in periods, they rehospitalized from outpatient and emergency department into neonatal department, and their rehospitalized rate was 94.3% (33/35). Level of birth medical institutions of late preterm newborns in study group between grade second and grade third was 45.7% (16/35) and 48.6% (17/35), respectively. Among the accompanied diseases or causes of 35 hyperbilirubinemia of late preterm newborns in study group, infection, ABO blood group incompatible hemolytic disease, glucose-6-phosphate dehydrogenase (G6PD) deficiency, cephalohematoma and multiple causes of diseases accounted for 17.1% (6/35), 11.4% (4/35), 5.7% (2/35), 2.9% (1/35), 5.7%(2/35), respectively; but there was the other 57.1% (20/35) still could not found a clear cause of hyperbilirubinemia. The incidence of bilirubin encephalopathy of late preterm newborns in study group was as high as 40% (14/35), and blood exchange rate was also as high as 62.9% (22/35). Conclusions In late preterm newborns with hyperbilirubinemia, the rate of severe and extremely severe hyperbilirubinemia, and incidence of bilirubin encephalopathy are high. And the rates of males, age≤7 d at the time of admission, 35+ 0-35+ 6 gestational weeks at birth, AGA infants, natural birth, complications were also high. Therefore, it is important to emphasize the training of health care workers for normative management of neonatal hyperbilirubinemia, and strengthening neonatal icterus monitoring perinatal management and other measures, so as to reduce disability and improve the life quality of late preterm newborns with hyperbilirubinemia. Key words: Hyperbilirubinemia; Severe and extremely severe hyperbilirubinemia; Kernicterus; Perinatal management; Late preterm newborns

To study the effect of golden-hour body temperature bundle management strategy on admission temperature and clinical outcome in preterm infants with a gestational age of <34 weeks after birth. The preterm infants who were born in the delivery room of the West China Second University Hospital of Sichuan University and admitted to the department of neonatology of this hospital within 1 hour after birth from December 2015 to June 2016 and from January to May, 2017 were enrolled. The 173 preterm infants who were admitted from January to May, 2017 were enrolled as the intervention group and were given golden-hour body temperature bundle management. The 164 preterm infants who were admitted from December 2015 to June 2016 were enrolled as the control group and were given conventional body temperature management. The intervention group had a significantly higher mean admission temperature than the control group (36.4±0.4°C vs 35.3±0.6°C; P<0.001). The incidence rate of hypothermia on admission in the intervention group was significantly lower than that in the control group (56.6% vs 97.6%; P<0.001). The intervention group had a significantly lower incidence rate of intracranial hemorrhage within one week after admission than the control group (15.0% vs 31.7%; P<0.05). Golden-hour body temperature bundle management for preterm infants within one hour after birth can reduce the incidence of hypothermia on admission and improve clinical outcome.

Objective To study perinatal management and outcomes for monochorionic diamniotic (MCDA) triplet pregnancies. Methods A retrospective study was conducted to evaluate perinatal management and outcomes of MCDA triplet pregnancies in West China Second University Hospital, Sichuan University from January 2012 to September 2017 including general clinical data, such as maternal age, primipara or multipara, pregnancy condition and prenatal examination, and pregnancy outcomes, such as delivery mode and perinatal outcomes and mortality. Meanwhile, placental and umbilical cord examination were given after delivery to identify the diagnosis of MCDA and umbilical cord entanglement. Results A total of 4 cases of MCDA triplet pregnancies included in our study all were primiparae and spontaneously conceived with age between 20 to 28 years. Two cases (No.1 and No.2 pregnant women) had regular prenatal examinations in our hospital and were diagnosed as MCDA triplet pregnancies at 13+ 4, 18+ 5 gestational weeks, respectively. They had caesarean section at 32+ 3, 32+ 5 gestational weeks and gave birth to six health and survival female babies. And the following-up results showed that all the 6 neonates grew well. And No.3 and No.4 pregnant women were transferred to our hospital due to preterm premature rupture of membranes (PPROM) at 28, 21+ 3 gestational weeks, respectively. Both of them did not have regular prenatal examinations. The diagnosis of MCDA triplet pregnancies were made during childbirth. No.3 pregnant woman had cesarean section due to maternal factor at 28+ 3 gestational weeks and gave birth to three male live babies. But these three newborns were died in 6 days after birth (1 newborn), 23 days after birth (2 newborns). No.4 pregnant woman gave birth to three dead fetus at 21+ 3 gestational weeks for inevitable abortion, and one still fetus (in single amniotic cyst) occurred abortion before admission in our hospital, and two fetuses were complicated with malformations (one fetus had cleft lip and palate, the other one were acardiac). The perinatal mortality of MCDA triplet pregnancies in this study was 11.1% (1/9). The placental and umbilical cord examination of 4 pregnant women were given after delivery, and all confirmed the prenatal diagnosis of MCDA triple pregnancies. The twin fetuses in single amniotic cyst of No.1, No.2, and No.3 pregnant women all had umbilical cord entanglement. Conclusions MCDA triplet pregnancies are very rare. To get a better perinatal outcome of MCDA triplet pregnancies, we recommend early diagnosis, regular prenatal examinations, close prenatal monitoring to improve prenatal care, and communication with patients and their families. Key words: Monochorionic diamniotic triplet pregnancies; Fetal monitoring; Perinatal managements; Perinatal outcome; Multiple birth offspring; Fetus

Objective To explore the heart rate variability (HRV) of dynamic electrocardiogram in children with benign or malignant ventricular premature beat (VPB) and healthy children, and analyze the changes of time and frequency domain indexes of HRV. Methods From January 2012 to December 2017, a total of 100 children with VPB diagnosed by auxiliary examinations and follow-up visits results, who were 6-14 years old and accepted dynamic electrocardiogram test in West China Second University Hospital, Sichuan University were recruited in this study. According to benign or malignant VPB, they were divided into benign VPB group (n=50) and malignant VPB group (n=50). Children in malignant VPB group were all combined with organic heart diseases, such as congenital heart defects (4 cases), dilated cardiomyopathy (DCM) (9 cases ), and viral myocarditis (37 cases) diagnosed by abnormal myocardial enzyme levels. Meanwhile, 50 cases of healthy children with the same age range who received dynamic electrocardiogram in the same hospital during the same period and the results were normal were included into control group. Measurement data with normal distribution and homogeneity such as standard deviation of all normal-to-normal intervals (SDNN), standard deviation of average normal-to-normal intervals (SDANN), root mean square of the successive difference (rMSSD), percentage normal-to-normal interval deviation greater than 50 ms (PNN50), coefficient of variance (CV), coefficient of variance (ULF), very-low frequencies (VLF), low frequencies (LF), and high frequencies (HF) were expressed by ±s. And those data among 3 groups were compared by one-way ANOVA, further comparisons between each two groups were conducted by least singnificant difference (LSD) test. Numeration data such as constituent ratio of genders were expressed by rate (%), and were compared by chi-square test among 3 groups. There were no significant differences among 3 groups in the constituent ratio of gender and age (P>0.05). This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Clinical informed consent was obtained from each child′s guardians. Results There were significant differences among 3 groups in HRV analysis results of time domain indicators such as SDNN, SDANN, rMSSD, PNN50, CV, and frequency domain indicators such as ULF, VLF, LF and HF (F=42.304, 14.144, 26.344, 15.362, 8.115, 18.031, 10.611, 20.928, 13.719; P 0.05), and PNN50 and HF between benign VPB group and control group (P>0.05), but there were significant differences in the others time domain indicators and frequency domain indicators of HRV between each two groups (P<0.05). Conclusions The HRV analysis of dynamic electrocardiogram is helpful in determining benign and malignant VPB in children. However, prospective randomized controlled trials with multicenter and large-sample size are needed to evaluate whether the HRV analysis can be used to determine the severity of VPB and as a prognosis marker in children with VPB. Key words: Arrhythmias, cardiac; Ventricular premature complexes; Heart rate variability; Electrocardiography; Controlled clinical trial; Child