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Objective To evaluate the clinical application value of positional management guided by 12-zone lung ultrasound（LUS） in the treatment of neonatal infectious pneumonia. Methods A total of 76 neonates with a gestational age of >36 weeks and corrected gestational age of P < 0.05）. On 7th day after the intervention， the LUS scores of dorsal in the treatment group were significantly lower than those in the control group （P < 0.05）， and in both groups， the LUS scores of dorsal remained significantly higher than those of the anterior and lateral chest （all P < 0.001）. Additionally， the LUS scores of chest were significantly higher than those of the anterior chest （P < 0.001）. The total LUS score on 7th day after the intervention in the treatment group were significantly lower than that in the control group（P < 0.05）， and compared to pre-intervention and the 3rd day after the intervention， the total LUS score in the treatment group showed a significant decrease （both P < 0.001）. The length of hospital stay in the treatment group was significantly shorter than that in the control group （P < 0.05）. Conclusion Positional management guided by 12-zone LUS is beneficial in promoting the recovery from neonatal infectious pneumonia and shortening the length of hospital stay.

Thoracic aortic aneurysm (TAA) is a life-threatening vascular disease frequently associated with underlying genetic causes. An inadequate understanding of human TAA pathogenesis highlights the need for better disease models. Here, we established a functional human TAA model in an animal host by combining human induced pluripotent stem cells (hiPSCs), bioengineered vascular grafts (BVGs), and gene editing. We generated BVGs from isogenic control hiPSC-derived vascular smooth muscle cells (SMCs) and mutant SMCs gene-edited to carry a Loeys-Dietz syndrome (LDS)–associated pathogenic variant (TGFBR1A230T). We also generated hiPSC-derived BVGs using cells from a patient with LDS (PatientA230T/+) and using genetically corrected cells (Patient+/+). Control and experimental BVGs were then implanted into the common carotid arteries of nude rats. The TGFBR1A230T variant led to impaired mechanical properties of BVGs, resulting in lower burst pressure and suture retention strength. BVGs carrying the variant dilated over time in vivo, resembling human TAA formation. Spatial transcriptomics profiling revealed defective expression of extracellular matrix (ECM) formation genes in PatientA230T/+ BVGs compared with Patient+/+ BVGs. Histological analysis and protein assays validated quantitative and qualitative ECM defects in PatientA230T/+ BVGs and patient tissue, including decreased collagen hydroxylation. SMC organization was also impaired in PatientA230T/+ BVGs as confirmed by vascular contraction testing. Silencing of collagen-modifying enzymes with small interfering RNAs reduced collagen proline hydroxylation in SMC-derived tissue constructs. These studies demonstrated the utility of BVGs to model human TAA formation in an animal host and highlighted the role of reduced collagen modifying enzyme activity in human TAA formation. Editor's summary: Thoracic aortic aneurysms (TAAs) form in patients with Loeys-Dietz syndrome (LDS), but in vivo models that recapitulate the pathophysiological features of early human disease are limited. Here, Yang and colleagues generated bioengineered vascular grafts using vascular smooth muscle cells (SMCs) derived from human induced pluripotent stem cells and implanted them into the common carotid arteries of nude rats to model TAA. Grafts seeded with cells containing a pathogenic variant in TGFBR1, which causes LDS, were shown to dilate in the face of strain caused by blood flow, and the authors found lower expression of collagen-related genes and impaired prolyl hydroxylase activity in uncorrected LDS grafts, suggesting that specific deficiencies in the extracellular matrix contribute to TAA formation in this disease. —Melissa L. Norton [ABSTRACT FROM AUTHOR]

Background To explore the influencing factors for in-hospital mortality in the neonatal intensive care unit (NICU) and to establish a predictive nomogram. Methods Neonatal data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Both univariate and multivariate logit binomial general linear models were used to analyse the factors influencing neonatal death. The area under the receiver operating characteristics (ROC) curve was used to assess the predictive model, which was visualized by a nomogram. Results A total of 1258 neonates from the NICU in the MIMIC-III database were eligible for the study, including 1194 surviving patients and 64 deaths. Multivariate analysis showed that red cell distribution width (RDW) (odds ratio [OR] 0.813, p=0.003) and total bilirubin (TBIL; OR 0.644, p<0.001) had protective effects on neonatal in-hospital death, while lymphocytes (OR 1.205, p=0.025), arterial partial pressure of carbon dioxide (PaCO2; OR 1.294, p=0.016) and sequential organ failure assessment (SOFA) score (OR 1.483, p<0.001) were its independent risk factors. Based on this, the area under the curve of this predictive model was up to 0.865 (95% confidence interval 0.813 to 0.917), which was also confirmed by a nomogram. Conclusions The nomogram constructed suggests that RDW, TBIL, lymphocytes, PaCO2 and SOFA score are all significant predictors for in-hospital mortality in the NICU. [ABSTRACT FROM AUTHOR]

A simple and environmentally friendly strategy for the synthesis of E-ortho-hydroxystilbenes has been established. Two kinds of α,β-unsaturated aromatic lactones, i.e. the 3-arylcoumarins and the isoaurones, could both readily undergo a cascade hydrolyzation/decarboxylation reaction in the presence of KOH in ethylene glycol to afford the desired E-ortho-hydroxystilbenes in moderate to high yields. [ABSTRACT FROM AUTHOR]

Background: Rebound hyperbilirubinemia (HBB) is still present in as high as 10% of newborn babies. However, the applicability of established prediction models for rebound HBB to Chinese newborns is unclear. This study aimed to establish a model to predict HBB rebound after phototherapy among Chinese neonates., Methods: A retrospective cohort study was conducted on 1,035 HBB infants receiving phototherapy. Rebound HBB was defined as total serum bilirubin (TSB) returning to or above the American Academy of Pediatrics (AAP) phototherapy threshold within 72 hours after the end of phototherapy. The predictive effects of previously published two- and three-variable scores were verified. Neonates were randomly assigned in a 6:4 ratio to the training (n=621) group and the testing (n=414) group. All variables in the training set were used to select predictors by least absolute shrinkage and selection operator (LASSO) regression analysis. The internal validation of the prediction model was performed using the testing set. The model's predictive performance was evaluated by area under the curve (AUC), accuracy, sensitivity, and specificity, each with 95% confidence intervals (CIs). Receiver operating characteristic (ROC) and calibration curves were constructed to evaluate the discrimination ability and fitting effect of the prediction model, respectively., Results: Rebound HBB was observed in 210 patients (20.3%). The AUC for the two- and three-variable scores were 0.498 (95% CI: 0.455-0.540) and 0.498 (95% CI: 0.457-0.540), respectively. Predictive factors for the risk of rebound HBB included formula feeding (>3 times/day), standard phototherapy irradiation time, TSB levels and age at termination of phototherapy, neonatal weight, and differences between TSB levels at the phototherapy termination and phototherapy threshold. The prediction model's AUC was 0.935 (95% CI: 0.911-0.958), the sensitivity was 0.880 (95% CI: 0.809-0.950), the specificity was 0.831 (95% CI: 0.790-0.871), and the accuracy was 0.841 (95% CI: 0.805-0.876)., Conclusions: The established model performed well in predicting rebound risk among Chinese infants with HBB, which may be beneficial in treating and managing HBB in infants., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-24-21/coif). The authors have no conflicts of interest to declare., (2024 Translational Pediatrics. All rights reserved.)

Objective: To determine the predictive values of different critical scoring systems for survival rate after discharge in critically ill patients supported by extracorporeal membrane oxygenation (ECMO)., Methods: The clinical data of 34 critically ill patients supported by ECMO admitted to Department of Emergency of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital) from July 2015 to September 2017 were retrospectively analyzed. The general information and the worst values of vital signs and related pathophysiological indicators within 12 hours before ECMO treatment of patients were collected, and sequential organ failure assessment (SOFA), multiple organs dysfunction score (MODS), simplified acute physiology score II (SAPS II), and acute physiology and chronic health evaluation IV (APACHE IV) scores were calculated. The patients were divided into survival group and non-survival group according to 28-day survival after hospital discharge. General clinical characteristics and aforementioned scores were compared between the two groups. Scoring systems for predicting prognosis were assessed by using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to depict the surviving curve., Results: Thirty-four patients were finally enrolled, 13 of whom were dead at the follow-up period of 28 days after hospital discharge, and 21 survived. Duration of ECMO support in non-survival group was significantly shorter than that in survival group (hours: 101.4±7.8 vs. 134.4±12.6), SOFA, SAPS II, and APACHE IV scores were significantly higher than those of survival group (SOFA score: 10.6±3.6 vs. 8.8±3.3, SAPS II score: 38.7±14.3 vs. 31.8±12.5, APACHE IV score: 46.5±15.5 vs. 38.1±11.3, all P < 0.05). There was no significant difference in gender, age, body mass index (BMI), vital signs or related pathophysiological indicators within 12 hours before ECMO treatment, or MODS score between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of SAPS II score for predicting 28-day survival rate was the highest, which was significantly higher than that of SOFA, MODS, and APACHE IV score (0.880 vs. 0.694, 0.654, 0.682, all P < 0.05). When the best cut-off value of SAPS II score was 43, the sensitivity was 81.2%, and the specificity was 77.9%. Kaplan-Meier survival analysis showed that 28-day survival rate after hospital discharge in patients with SAPS II score < 43 (n = 18) was significantly higher than that in patients with SAPS II score ≥ 43 (n = 16; χ 2 = 2.444, P = 0.018)., Conclusions: Four critical scoring systems of SOFA, MODS, SAPS II and APACHE IV have been proved to have good prognostic ability to predict 28-day survival after hospital discharge in critically ill patients supported by ECMO. Among them, SAPS II score system has more accurate prediction value.