Elabela is a reliable biomarker for predicting early onset preeclampsia:A comparative study

BACKGROUND Preeclampsia(PE)is a multisystemic metabolic disease with an undetermined etiology.PE is a worldwide cause of maternal and perinatal morbidity,subdivided into early(EoPE)and late-onset(LoPE)according to 34 wk of gestation as a divider.Many researchers investigated biomarkers for predicting PE to halt its consequences on the feto-maternal outcome.Elabela(Ela)is a newly discovered peptide hormone that was implicated in PE pathogenesis.Earlier rodent studies discussed Ela’s role in controlling blood pressure.Moreover,Ela deficiency was associated with PE development.AIM To test whether plasma Ela could serve as a reliable marker for predicting PE based on the time of onset(EoPE vs LoPE)compared to age and body mass matched healthy controls since no definitive treatment exists for PE but to terminate a pregnancy.METHODS This case-control study recruited(n=90)pregnant who fulfilled inclusion criteria;they were allocated into three groups:EoPE(30/90)(<34 wk of gestation);LoPE(30/90)(≥34 wk of gestation);and healthy pregnant(30/90).Demographic criteria;biochemical,hematological,and maternal plasma Ela levels were recorded for comparison.RESULTS Serum Ela was significantly reduced in EoPE compared to LoPE and healthy controls(P=0.0023).The correlation confirmed a strong inverse relationship with mean atrial blood pressure(r=-0.7,P<0.001),while gestational age and platelets count showed a moderate correlation with(r=0.4 with P<0.0001).No correlation was confirmed between the body mass index(BMI)and urine albumin.The predictive ability of 25 centile serum Ela had an Odds ratio of 5.21,95%confidence interval(1.28,21.24),P=0.02 for predicting EoPE.The receiver operator characteristic curve defined the Ela cutoff value at>9.156 with 96.7%and 93.3%sensitivity and specificity,P<0.0001 in predicting EoPE.CONCLUSION A strong correlation of serum Ela with PE parameters with excellent sensitivity and specificity in distinguishing EoPE independent of the BMI,age,and blood pressure which makes Ela a recommendable marker in screening.Further research is warranted to explore prognostic and therapeutic applications for Ela in PE.

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia:A single-center experience

BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomarker,as a marker to predict poor maternal-neonatal outcomes in early-onset PE(EoPE).METHODS A cross-sectional study enrolled 60 pregnant women with EoPE(at 32-30 wk of gestation)at a university hospital.Demographic criteria and hematological indices were collected,including platelet counts and indices(mean platelet volume and platelet distribution width),PLR,and the Doppler study,which calculated estimated fetal weight(EFW),amniotic fluid index(AFI),resistance index(RI),and pulsatility index(PI).Participants were followed until delivery,where maternal outcomes were recorded,including;delivery mode and reason for cesarean section,and neonatal outcomes,including fetal growth restriction(FGR),meconium-stained liquid,the 5-min Apgar score,and admission to the intensive care unit.RESULTS There was a trend of insignificant increases in cesarean sections.Sixty-one-point two percent(37/60)fetuses were admitted to the neonatal care unit;70.0%of admitted fetuses were meconium-stained liquor,and 56.7%of them had FGR.PLR was positively correlated with AFI and EFW as r=0.98,0.97,P<0.001;PLR showed negative correlations with PI and RI as r=-0.99,-0.98,P<0.001.The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation(0.69,-0.98),P<0.0001,respectively.Receiver operating characteristic calculated a PLR cutoff value(7.49)that distinguished FGR at 100%sensitivity and 80%specificity.CONCLUSION Strong,meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications.Further studies are suggested to see the impact on maternal-neonatal health.

Atypical Symptoms of Early Onset Bipolar Disorder

Juvenile bipolar disorder can be a challenging diagnosis, given its atypical presentation and tendency to have other comorbid psychiatric disorders. In this case study, we describe a case of a young patient with some atypical symptoms of early-onset bipolar disorder.

Effect of EME1 exon variant Ile350Thr on risk and early onset of breast cancer in southern Chinese women

Essential meiotic endonuclease 1 homolog 1 （EME1） is a key DNA repair protein that participates in the rec- ognition and repair of DNA double-strand breaks. Deficiency of the EME1 gene can lead to spontaneous genomic instability and thus contribute to tumorgenesis. We hypothesized that the exon variants of EME1 confer genetic susceptibility to breast cancer. In a case-control study of 748 breast cancer patients and 778 normal controls, we analyzed the association between two exon variants of EME! （i.e.,Ile350Thr： rs12450550T 〉 C and Glu69Asp： rs3760413T 〉 G） and breast cancer risk. We found that compared to the common lie/lie genotype, the Thr variant genotypes （Thr/lle ＋ Thr/Thr） conferred a 1.47-fold increased risk of breast cancer （OR=1.47, 95% CI=I. 13-1.92）. The variant Ile350Thr was also associated with early onset of breast cancer （r = -0.116, P = 0.002）. The mean age of onset was 44.4 years for Thr/Thr genotype carders and 46.5 years for Thr/lle genotype carriers, which was significantly lower than that （49.4 years） for Ile/Ile genotype carriers （P = 0.006）. Moreover, no significant as- sociation was observed between the Glu69Asp variant and breast cancer risk. Our findings suggest that the EME1 variant Ile350Thr contributes to an increased risk and early onset of breast cancer.

A Study on Apolipoprotein E Polymorphism in Early Onset of Coronary Heart Disease

Objective :To assess the relationship between apolipoprotein E(apoE) polymorphism and early onset of Coronary heart disease(CHD) and the effect of apoE on lipids and tipoproteins in Chinese healthy subjects. Methods:Sixty-eight cases (CHDl) aged less than 55 y, 136 coses (CHD2) aged more than 65y with CHD and 136 healthy subjects were enrolled and their -plasma levels of triglyceride(TG) , total cholesterol (TC) and high density Upoprotein cholesterol (HDL-C) were determined. The apoE genotypes were identified by polymerase chain reaction-restriction fragment lengths polymorphism. Results -apoE3/4 genotype and E4 allele frequency in CHDl were higher than those in CHD2 and healthy subjects and no difference was found between CHD2 and healthy subjects. Meanwhile the plasma levels of TC and low density Upoprotein cholesterol(LDL-C) were higher in CHD2 than in either CHDl or healthy subjects. Each apoE isoprotein has variable TC and LDL-C levels characterized by E2 (E2/2 + E2/3) <E3(E3/3) <E4(E4/4 + E3/4). Conclusion.apoE is one of the genetic factors that affect the TC and LDL-C levels and apoE4 may be an independent genetic factor of early onset of CHD.

A Comparison between Late Preterm and Term Infants with Respiratory Distress Syndrome, Early-Onset Sepsis, and Neonatal Jaundice in Ecuadorian Newborns

Background: To examine the differences in prevalence of respiratory distress syndrome, early-onset sepsis and jaundice, between late preterm infants versus term infants in Ecuadorian newborns. Methods: Study design: Epidemiological, observational, and cross-sectional, with two cohorts of patients. Settings: IESS Quito Sur Hospital at Quito, Ecuador, from February to April of 2020. Participants: This study included 204 newborns, 102 preterm infants, 102 term infants. Results: There are significant differences between late preterm infants and term infants, with a p-value of 0.000 in the prevalence of early sepsis, 70.59% vs. 35.29%. In respiratory distress syndrome between late and term premature infants, significant differences were observed with a p-value of 0.000, the proportion being 55.58% vs. 24.51% respectively. The prevalence of jaundice is higher in term infants with a p value of 0.002, 72.55%, versus 51.96% in late preterm infants, and the mean value of bilirubins in mg/dL was higher in term infants 14.32 versus 12.33 in late preterm infants;this difference is statistically significant with a p value of 0.004. Admission to the NICU is more frequent in late preterm infants with a p-value of 0.000, being 42.16% for late preterm infants vs. 7.84% in term infants;the mean of the hospital days with p-value 0.005, was higher in late preterm infants 4.97 days vs. 3.55 days for term newborns. Conclusion: Due to the conditions of their immaturity, late preterm infants are 2.86 times more likely to present early sepsis than full-term newborns. It is shown that late preterm infants are 2.69 times more likely to have respiratory distress syndrome compared to term infants, therefore, late preterm infants have a longer hospital stay of 4.97 days versus 3.55 days in term infants. Jaundice and mean bilirubin levels are higher in term infants due to blood group incompatibility and insufficient breastfeeding.

Effect of high-fat diet on liver and placenta fatty infiltration in early onset preeclampsia-like mouse model

Background Preeclampsia, especially early onset of preeclampsia （PE）, is a common and serious disorder with high maternal and perinatal morbidity and mortality. Dietary factor is one of the most important factors which may affect the occurrence and development of the disease. The aim of this study is to investigate the effects of dietary factors on pathological changes of liver and placenta in preeclampsia-like mouse model by establishing the model at multiple stages of gestation. Methods Wild-type （WT） mice were injected subcutaneously with nitric oxide synthase （NOS） inhibitor L-arginine methyl ester （L-NAME, 50 mg·kg^-1·d^-1） to establish PE-like model （L-NAME group） at early-, mid-, and late- pregnant periods respectively; simultaneously, the control mice were injected with normal saline （NS group）. All the groups were divided into subgroups, standard chow group （SC）, and high-fat diet group （HF）. ApoE^-/- pregnant mice served as a control group. Systolic blood pressure （SBP）, urine protein, and histopathologic changes of placenta and liver in all groups were observed and statistically analyzed. Results In WT and apoE^-/- L-NAME subgroups, blood pressure and urine protein were significantly higher than those in all the gestational age matched NS groups （P 〈0.05）. Compared to other groups, remarkable liver fatty infiltration and lipid storage in placenta were found in early- and mid-L-NAME subgroups in apoE^-/- mice （P 〈0.05）, especially in the early- and mid-HF＋L-NAME subgroups in apoE^-/- mice （P 〈0.05）. More lipid storage droplets both in liver and placenta were found in ApoE^-/- mice than that of WT groups （P 〈0.05）. Morphology histopathologic examination of placentas showed varying degrees of fibrinoid necrosis and villous interstitial edema in early- and mid-L-NAME both in HF and SC of apoE^-/- and WT subgroups compared to NS controls （P 〈0.05）. But there was no significant difference between HF and SC subgroups （P 〉0.05）, and no difference between apoE^-/-and WT groups （P 〉0.05）. Conclusions Preeclampsia-like conditions could be induced by L-NAME in mice at different gestational stages. Both WT and apoE^-/- genotype mice with preeclampsia-like symptoms in early and mid stages of pregnancy presented lipid deposition in the placenta and hepatic fatty infiltration. To alter the environmental condition by feeding high-fat diet was harmful to the mother and the fetus. High-fat diet aggravated the impact of liver fatty infiltration at early and mid gestational stages especially in the apoE^-/- mouse model. These results further revealed the association between early-onset preeclampsia and the dysoxidation of fatty acids.

Approach to early-onset colorectal cancer:Clinicopathological,familial,molecular and immunohistochemical characteristics

AIM:To characterize clinicopathological and familial features of early-onset colorectal cancer(CRC) and compare features of tumors with and without microsatellite instability(MSI).METHODS:Forty-five patients with CRC aged 45 or younger were included in the study.Clinical information,a three-generation family history,and tumor samples were obtained.MSI status was analyzed and mismatch repair genes were examined in the MSI families.Tumors were included in a tissue microarray and an immunohistochemical study was carried out with a panel of selected antibodies.RESULTS:Early onset CRC is characterized by advanced stage at diagnosis,right colon location,low-grade of differentiation,mucin production,and presence of polyps.Hereditary forms represent at least 21% of cases.Eighty-one percent of patients who died during followup showed a lack of expression of cyclin E,which could be a marker of poor prognosis.β-catenin expression was normal in a high percentage of tumors.CONCLUSION:Early-onset CRC has an important familial component,with a high proportion of tumors showing microsatellite stable.Cyclin E might be a poor prognosis factor.

Genetics on early onset inflammatory bowel disease:An update

Inflammatory bowel disease(IBD)is more common in adults than in children.Onset of IBD before 17 years of age is referred as pediatric onset IBD and is further categorized as very early onset IBD(VEO-IBD)for children who are diagnosed before 6 years of age,infantile IBD who had the disease before 2 years of age and neonatal onset IBD for children less than 28 days of life.Children presenting with early onset disease may have a monogenic basis.Knowledge and awareness of the clinical manifestations facilitates early evaluation and diagnosis.Next generation sequencing is helpful in making the genetic diagnosis.Treatment of childhood IBD is difficult;targeted therapies and hematopoietic stem cell transplantation form the mainstay.In this review we aim to summarize the genetic defects associated with IBD phenotype.We describe genetic location and functions of various genetic defect associated with VEO-IBD with their key clinical manifestations.We also provide clinical clues to suspect these conditions and approaches to the diagnosis of these disorders and suitable treatment options.

Comparison of initial efficacy between single and dual growing rods in treatment of early onset scoliosis

Background Initial results for the use of single and dual growing rod techniques in the treatment of early onset scoliosis （EOS） has been seldom documented. The aim of this research was to investigate the initial efficacy of single and dual growing rods in treatment of EOS. Methods A retrospective study of 25 early onset scoliosis cases treated with growing rod technique between November 2002 and May 2010 was performed, including six cases in the single growing rod group and 19 cases in the dual growing rod group. Operation time, intra-operative bleeding, correction rate, changes in C7-S1 distance, and incidence of complications of the first operation were compared for the two techniques. Results The average post-operative follow-up duration was 31.9 months. There was no statistical difference observed between operation time, intra-operative bleeding, and complication incidence between the single and dual growing rod groups. In addition, no statistical difference was observed in the pre-operative coronal Cobb＇s angle （P 〉0.05）, or in the pre-operative sagittal Cobb＇s angle between both groups （P 〉0.05）. The correction rate of the dual growing rod group was significantly superior to that of the single growing rod group in the coronal plane （P 〈0.01）, but not in the sagittal plane （P 〉0.05）. The C7-S1 distance in the dual growing rod group was significantly larger than that in the single growing rod group （P 〈0.05）. Conclusions The growing rod technique is an effective option for surgical treatment of EOS. The dual growing rod technique shows relative superiority in the correction outcome as compared to the single growing rod technique.

Application of Kaiser Sepsis Calculator in culture-positive infants with early onset sepsis

Background Kaiser Sepsis Calculator(KSC)reduces antibiotic use,testing and intravenous infiltrates but there are concerns about the missed early onset sepsis(EOS)cases.We sought to apply the KSC score for culture-positive infants retrospectively in infants born in the last 10 years in our hospital.Methods In a retrospective cohort study,the comparison groups were divided into Group A(no antibiotics recommended by KSC)and Group B(antibiotics recommended).Results Overall,17/24(71%)infants would have been started on antibiotics per KSC but 7/24(29%)would not.The initial EOS risk was not significantly different between the groups(Group A vs.Group B:0.44 vs.0.76,P=0.41),but the final risk score was(0.33 vs.9.41,P<0.001).In Group A(no antibiotics),3/7 infants became symptomatic between 9 and 42 hours.Conclusion There may be a potential delay in starting antibiotics in infants that are asymptomatic at birth while using KSC.

Relationship between fever and early clinical diagnosis and treatment in mild COVID-2019 patients

Objective:To investigate the relationship between clinical manifestations,blood testing,chest CT,treatment and fever of 457mild cases of COVID-19.Methods:A tatal of 457cases of mild COVID-19 diagnosed in Wuhan Jianghan module Hospital from February 6,2020 to February 26,2020 were gathered,and the cases with/without fever were retrospectively analyzed in epidemiology,clinical manifestation,blood routing,hypersensitive C-reactive protein(hs-CRP),pathogens serological testing,chest CT and drugs treatment.Results:For 312 fever cases,the average age was(47.6±10.9)years old,male was 128 cases(41%),the mean peak fever was 38(36.8,38.6)℃,fever lasting was 2(0,3)days,131cases(28.7%)had Huanan seafood market exposure history,90 cases(28.8%)had closely contact with COVID-19 patients,20cases(6.4%)had hypertension history,10 cases(3.2%)had diabetes,5cases(1.6%)had coronary heart disease.Main symptoms of fever group including dry cough of 260cases(83.3%),of 104cases(33.3%),blood sputum of 9cases(2.9%),chest tightness 20cases(19.6%),shortness of breath of 87cases(27.9%),weak of 105cases(33.7%),diarrhea of 43cases(13.8%),sleep disorders of 61cases(19.6%),among fever cases with sputum and shortness of breath more rather without fever,and two groups were statistically significantly difference(P<0.05).In fever group,WBC(109/L)[4.34(3.69,5.26)than 5.11(4.22,6.22),P<0.001],NEUT(109/L)[2.67(2.1,3.49)than 2.88(2.37,3.9),P<0.05],LYM(109/L)[0.9(0.8,1.1)than 1.36(1.03,1.85),P<0.001),PLT(109/L)/(106,188)134-189(132,224),P<0.001)were lower than normal group,while WBC<4.0×109/L[108(34.6%)than 24(16.6%),P<0.001)],LYM<1.0×109/L[189(60.6%)than 31(21.4%),P<0.001)],PLT<100×109/L[45(14.4%)than in 2(1.4%),P<0.001)and hs-CRP(mg/L)[14(6.83,32)than 3.4(0.96,10.75),P<0.001)were higher than normal group,and pathogens serological examination of 36cases shown influenzaⅠ/Ⅱvirus IgM antibody positive in 3cases(8.3%),respiratory syncytial virus IgM antibody positive in 2 cases(5.6%),mycoplasma pneumoniae IgM antibody positive(11.1%),4 cases of adenovirus IgM antibody positive(11.1%),but 4 pathogens of fever group and normal group were no statistical difference(P>0.05).According to early onset of chest CT examination,there were no change of 11cases(2.4%),unilateral lung lesions of 93cases(20.4%),bilateral lung lesions of 353 cases(77.2%),ground glass shadow of 228 cases(73.1%),high density shadow patch of 65 cases(20.8%),consolidation shadow of 6 cases(1.9%),while fever group compared with normal group,there were no statistically significant difference(P>0.05).Logistic regression analysis showed that LYM(OR=0.24,95%CI=0.139~0.415,P<0.001),LYM<1.0 x 109/L(OR=5.12,95%CI=3.07~8.65,P<0.001),PLT<100×109/L(OR=6.1,95%CI=1.36~27.33,P<0.05),and the hs-CRP(OR=1.03,95%CI=1.02~1.05,P<0.001)were fever independent impact factors in mild COVID-19.Aiming at COVID-19 treatment,Chinese medicine usage had 416cases(91%),antiviral drugs had 328cases(71.8%),and antibiotics had 172cases(37.6%),furthermore,fever group using antiviral and antibiotic drugs was higher than normal group(P<0.05),and compared to low fever group,high fever group used more antibiotic drugs(P<0.05).Conclusions:Mild COVID-19 patients with early onset had epidemiological characteristics,and fever,dry cough,expectoration and shortness of breath were main symptoms,and chest CT often involved bilateral lung lesions,ground glass shadow and patch density shadow.The fever patients in WBC,LYM,PLT,hs-CRP index changed significantly and could affect on anti-infective therapy selection.

Relationship between Indian Ocean dipole and ENSO and their connection with the onset of South China Sea summer monsoon

Using Reynolds and Smith 1950 - 1998 re-constructed monthly-mean SST to discuss the relationship between the ENSO and Indian Ocean dipole （IOD） and their possible connection with the onset of South China Sea summer monsoon（ SCSSM）, the results are obtained as follows ： Most of IOD events have a closely positive relation to simultaneous ENSO events in summer and autumn. IOD events in autumn （ mature phase） are also closely related to ENSO events in winter （ mature phase）. When these two kinds of events happen in phase, i.e. , positive （negative） IOD events are coupled with E1 Nifío （La Nifía） events, they are always followed by late （ or early） onsets of SCSSM. On the contrary, when these two kinds of events happen out of phase, i.e. positive （negative） IOD events are coupled with La Nifia （ E1 Nifío） events, they are followed by normal onsets of SCSSM. In addition, single IOD events or single ENSO events cannot correspond well to the abnormal onset of SCSSM.

Genetic counseling in post-genomic era: Don't pretend to know the meaning of a gene mutation if you don't know

In this post-genomic era, more and more susceptibility loci of many possible genetic diseases are published. As our knowledge about these susceptibility loci is limited and partial, we should be very careful and responsible when patients seek genetic counseling about these possible genetic diseases. We should apply Confucius' s principle about knowledge and information to genetic conseling, and tell the truth to our patients about what we know and what we do not know. Like many other cancers, breast cancer is a very complicated, multifactorial disease; genetic factors, lifestyles and eating habits, environmental factors, and viral infections might be involved in breast cancer; hence, it is difficult to figure out the real etiology of breast cancer. It is not crystal clear that a person who carries mutations of the breast cancer 1, early onset and/or breast cancer 2, early onset genes would eventually get breast cancer in her/his lifetime. No person should undergo a preventive double mastectomy, unless we know the etiology of breast cancer someday.

早发型重度子痫前期期待治疗的护理进展

子痫前期是妊娠期特有的疾病,对于早发型重度子痫前期的孕妇来说,会增加孕妇以及胎儿在围产期的病死率,早发型重度子痫前期患者在期待治疗中采用预见性评估、一般处理、预见性护理干预、降压、解痉、用药观察、促胎肺成熟及会阴护理等方法。实施期待治疗,期待治疗可有效改善母婴结局,可有效地提高护理质量,达到良好的治疗效果并提高患者满意度。

Colorectal cancer patients in a tertiary hospital in Indonesia: Prevalence of the younger population and associated factors

BACKGROUND An increasing trend in colorectal cancer(CRC)occurring at younger ages has been observed worldwide,even though incidence is declining in the general population.Most currently available guidelines still recommend CRC screening for older populations,despite an alarming rise in early-onset CRC incidence.Risk stratification is necessary to further determine the population most at risk for early-onset CRC.However,epidemiological data on related clinical characteristics and potential risk factors,especially in developing countries,have not been widely reported.AIM To investigate the prevalence,demographics,clinicopathologic features,and associated factors of young-onset CRC patients in a tertiary hospital in Indonesia.METHODS Patients undergoing colonoscopy examination between 2008 and 2019,yielding a diagnosis of CRC were identified from medical records.The subjects were classified into two groups according to their age at diagnosis,namely early-onset(18-49 years old)and late-onset(≥50-years-old).Demographic data,characteristics,and risk factors of both onset age groups were evaluated using the chisquare and Fisher’s exact test.RESULTS Among 495 CRC patients confirmed by histopathology,205(41.4%)were classified as early-onset and 290(58.6%)as late-onset.Most subjects in the earlyonset CRC group were male(53.7%),with 89.8%displaying adenocarcinoma histopathology.A majority(78%)of the early-onset CRC patients had left-sided tumors,with the rectum(41%)and rectosigmoid(17.6%)being the most common sites.Abdominal pain was the most frequent symptom in the early-onset CRC patients(55.6%),which was significantly higher than that in the late-onset CRC patients(43.8%,P<0.05).Early-onset CRC cases were more likely to be underweight(34.6%vs 20.0%,P<0.001)compared to late-onset CRC cases.The proportion of subjects with suspected hereditary nonpolyposis colorectal cancer(HNPCC)was also higher in the early-onset CRC group than in the late-onset age group(9.3%vs 4.1%,P<0.05).However,no difference was observed in the parental or family histories of CRC cases.CONCLUSION Early-onset CRC patients were more likely to have abdominal pain,underweight status,and HNPCC suspicion than late-onset CRC patients.

Screening for early-onset neonatal sepsis on the Kaiser Permanente sepsis risk calculator could reduce neonatal antibiotic usage by two-thirds

Importance:Effective screening strategies for early-onset neonatal sepsis(EONS)have the potential to reduce high volume parenteral antibiotics(PAb)usage in neonates.Objective:To compare management decisions for EONS,between CG149 National Institute for Health and Care Excellence(NICE)guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator(SRC)in a level 2 neonatal unit at a district general hospital(DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS,neonatal clinical examination findings,and microbial culture results for all neonates born at≥34 weeks’gestation between February and July 2019,who were(1)managed according to CG149-NICE guidelines or(2)received PAb within 72 h following birth at a DGH in Winchester,UK.SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period.Of these,19(31.7%)met SRC criteria for antibiotics;20(33.3%)met the criteria for enhanced observations and none had culture-proven sepsis.Based on SRC projections,neonates with’’≥1 NICE clinical indicator and≥1 risk factor’were most likely to have a sepsis risk score(SRS)>3.Birth below 37 weeks’gestation(risk ratio[RR]=2.31,95%confidence interval[CI]:1.02–5.22)and prolonged rupture of membranes(RR=3.14,95%CI:1.16–8.48)increased the risk of an SRS>3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68%in term and near-term neonates in level 2 neonatal units.

Effects of preeclampsia-like symptoms at early gestational stage on feto-placental outcomes in a mouse model

Background Early and late-onset preeclampsia is thought to be different disease entities. This study aimed to determine the effects of early-onset preeclampsia-like symptoms on feto-placental outcomes and the adverse impacts of various factors on placental and fetal growth and development at different gestational stages in a mouse model. Methods Pregnant C57BL/6J mice were divided into control and preeclampsia （PE） groups, and injected subcutaneously with the nitric oxide synthase inhibitor L-arginine methyl ester （L-NAME） 50 mg·kg^-1·d^-1. The PE group was divided into early-, mid- and late-PE groups with L-NAME injections starting on days 7, 11 and 16 of pregnancy, respectively. Corresponding control groups were injected with saline at the same time points. Blood pressure was measured until days 14 and 18, when the fetuses and placentas were removed under anesthesia. Blood pressure, urinary protein, and fetal and placental conditions were analyzed. Results Blood pressure and urinary protein increased following L-NAME injection. The fetal survival rate and fetal weight were reduced and the fetal absorption rate was increased in the early-PE group on days 14 and 18 of pregnancy, compared with the control group. There were no significant differences in these parameters between the late-PE group and the respective control group. Placental weights in the early- and mid-PE groups were significantly reduced at days 14 and 18 of pregnancy compared with the control groups, but there was no significant difference in placental weight between the late-PE group and the respective control group. Morphologic examination of placentas from the early- and mid-PE groups showed varying degrees of fibrinoid necrosis and villous interstitial edema, but no significant pathologic changes were found in the placentas from the late-PE or control groups. Conclusion Preeclampsia-like symptoms occurring during the early stage of pregnancy are more likely to affect placental and fetal development, whereas late onset preeclampsia-like symptoms have a direct impact on the mothers.