ABSTRACT
Objective:To summarize the clinical features and risk factors of periventricular venous cerebral infarction (PVI) in premature infants to prompt an early diagnosis.Methods:Clinical data of 16 premature newborns diagnosed with PVI by ultrasound in the Department of Pediatrics of Peking University Third Hospital from January 1, 2013, to December 31, 2018, were retrospectively collected. The clinical manifestations, ultrasound findings, risk factors and outcomes were analyzed. Two allocations were performed to the patients: mild PVI group ( n=5) or severe PVI group ( n=11) according to the degree of brain injury suggested by ultrasound findings; and typical PVI group (onset time was 6-96 h after birth; n=14) or atypical PVI group (onset time was less than 6 h or more than 96 h after birth; n=2) according to the onset time. Chi-square or Fisher's exact test was used to analyze the differences in high risk factors and prognosis between the groups. Univariate and multivariate logistic regression analysis were used to analyze the high risk factors related to different groups. Correlations of the severity of brain injury and the onset time with PVI prognosis were analyzed using univariate analysis. Results:(1) The gestational age of the 16 infants with PVI was 25 +2-33 +1 weeks (median 27 weeks). The birth weight ranged from 660 g to 1 760 g (median 1 065 g). All cases showed PVI under ultrasongraphy one week after birth, among which 11 was diagnosed and the other five were misdiagnosed as periventricular intraventricular hemorrhage Grade Ⅲ. Five cases presented with convulsion, while the others did not show any specific symptoms. All cases were shown periventricular intraventricular hemorrhage GradeⅢ or above. Bilateral hemispheres were involved in seven cases, left hemisphere in five and right in four. There were 15 cases with massive infarction and six with midline displacement. Obstructive hydrocephalus occurred in six cases 4-25 d after birth, and eight patients had brain parenchyma softening 5-25 d after birth. (2) The incidence of asphyxia in the mild PVI group was lower than that in the severe PVI group (1/5 vs 10/11, P=0.013) and asphyxia was a high risk factor of severe PVI ( OR=40.000, 95% CI: 1.982-807.100). (3) There was no significant difference in the clinical risk factors between the typical and atypical PVI groups (all P>0.05). (4) Among the 16 cases, nine died, one was lost to follow-up, five had delayed intelligence and motor development and one had normal growth and development. No significant difference in the prognosis (died or discharged after improvement) was found between the mild and severe PVI groups, or between the typical and atypical PVI groups ( P=0.365 or 0.700). Conclusions:PVI usually occurs in very or extremely low birth weight premature infants within one week after birth. Clinical manifestations of PVI include convulsions, but most are non-specific. Asphyxia may lead to severe PVI. PVI has a higher short-term mortality as well as a higher incidence of long-term neurological sequelae.
ABSTRACT
Objective To evaluate the effect of doxofylline on pulmonary inflammatory response induced by mechanical ventilation in rats with chronic obstructive pulmonary disease (COPD).Methods Thirty adult male Sprague-Dawley rats,aged 8 weeks,weighing 200-250 g,were divided into 3 groups (n=10 each) using a random number table method:control group (C group),COPD group and doxofylline group (Dox group).Rats were fed in normoxia for 2 months,and normal saline 0.2 ml was injected into the trachea on 1st and 30th days in C group.Rats were exposed to cigarette smoke for 30 min every day,lasting for 2 months,and lipopolysaccharide 200 μg (0.2 ml) was injected into the trachea on 1st and 30th days in COPD and Dox groups.Two months later,rats in each group were anesthetized,tracheally intubated,and then mechanically ventilated.Doxofylline 50 mg/kg was intravenously injected immediately after intubation in Dox group,and the equal volume of normal saline was given instead in C and COPD groups.Pulmonary specimens were taken after 120 min of mechanical ventilation for examination of pathological changes and for determination of wet/dry weight ratio (W/D ratio) and tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) contents (by enzyme-linked immunosorbent assay).Results No significant pathological change of lung tissues was found in C group,and COPD pathological changes were observed in COPD and Dox groups.Compared with C group,the W/D ratio and TNF-α level were significantly increased,and the IL-10 level was decreased in COPD and Dox groups (P＜0.05).Compared with COPD group,the W/D ratio and TNF-α level were significantly decreased,and the IL-10 level was increased in Dox group (P＜0.05).Conclusion Doxofylline can reduce the pulmonary inflammatory response induced by mechanical ventilation in rats with COPD.
ABSTRACT
Objective To investigate an efficient rapid method for the isolation and cultivation of human axillary dermal papilla cells.Methods Skin specimens with hair follicles were obtained from the axillary area of patients who received bromhidrosis surgery in the Department of Dermatology of the First Affiliated Hospital to Army Medical University from October 2015 to May 2016.The axillary dermal papilla cells were isolated by two-step enzyme digestion method,one-step digestion method and micro-dissection method separately.Then,axillary dermal papilla cells were cultured and identified.Differences in the operative procedure,separation efficiency and adhesion efficiency of dermal papilla cells,cell emigration duration,total operation duration and actual operation duration were compared among the above 3 methods.Results Compared with the one-step digestion method and micro-dissection method,the two-step enzyme digestion method showed simpler operative procedure,more than 30％ separation rate and 96％ adhesion rate of dermal papilla cells after 1 week.Moreover,the cell emigration duration was shortened by 3-4 days by the two-step enzyme digestion method.The two-step enzyme digestion method also showed longer total operation duration,but shorter actual operation duration compared with the one-step digestion method and micro-dissection method,as well as lower contamination rate compared with the micro-dissection method.Cultured axillary dermal papilla cells grew in an aggregative pattern in the early stage,but grew in a nonaggregative pattern after 6 passages.Immunofluorescence assay showed positive staining for laminin and collagen Ⅳ in axillary dermal papilla cells.Conclusion The modified two-step enzyme digestion method is a kind of simple,efficient and rapid method for the isolation of human axillary dermal papilla cells,and axillary dermal papilla cells can be harvested through this method by using a few specimens.
ABSTRACT
Objective To evaluate the effects of penehyclidine hydrochloride (PHCD) combined with high-frequency jet ventilation (HFJV) of the operated lungs on pulmonary function and inflammatory response during one-lung ventilation (OLV) in patients with chronic obstructive pulmonary disease (COPD).Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes with COPD,aged 40-64 yr,with body mass index of 17-26 kg/m2,scheduled for elective video-assisted thoracoscopic surgery under general anesthesia,were divided into 4 groups (n =15 each) using a random number table method:conventional group (group C),PHCD group (group P),HFJV group (group H) and PHCD combined with HFJV group (group PH).After induction of anesthesia,the patients were intubated with a double-lumen tube and then mechanically ventilated,with inspired oxygen concentration 100％,oxygen flow rate 2 L/min,tidal volume 6-8 ml/kg,respiratory rate 10-14 breaths/min,and respiratory rate was set at 12-16 breaths/min and PETCO2 was maintained at 40-45 mmHg during OLV.PHCD 0.01 mg/kg was intravenously injected before intubation in P and PH groups.The ventilation mode was changed to OLV after beginning of skin incision in each group.Ventilation of the lung on the operated side was performed by means of HFJV (driving pressure 0.5 kg/cm2) during OLV in P and PH groups.The pneumodynamic parameters such as airway peak pressure (Ppeak),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were monitored immediately before skin incision (T1) and at 60 and 120 min of OLV (T2,3).Arterial blood samples were obtained at T2 for blood gas analysis,and oxygenation index (OI),respiratory index (RI),physiologic dead space fraction (VD/Vr)and alveolar-arterial oxygen gradiant (A-aDO2) were calculated.Venous blood samples were drawn at T3 for determination of the serum concentrations of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6)and IL-8 by enzyme-linked immunosorbent assay.The occurrence of pulmonary complications was recorded within 72 h after operation.Results Compared with group C,the serum concentrations of TNF-α,IL-6 and IL-8,Ppeak,Pplat,Raw,RI,VD/VT,A-aDO2 and incidence of pulmonary complications were significantly decreased,and Cdyn and OI were increased in group P and group PH (P＜0.05),and the serum concentrations of TNF-α,IL-6 and IL-8,RI,VD/VT,A-aDO2 and incidence of pulmonary complications were significantly decreased,and OI was increased in group H (P＜0.05).Compared with group P or group H,the serum concentrations of TNF-α,IL-6 and IL-8,RI,VD/VT,A-aDO2 and incidence of pulmonary complications were significantly decreased,and OI was increased in group PH (P＜0.05).Conclusion PHCD combined with HFJV of the operated lung produces better efficacy in improving respiratory function,inhibiting inflammatory responses,reducing lung injury and is more helpful in improving prognosis than either alone in the patients with COPD.
ABSTRACT
Objective To determine the prognosis and risk factors of neonatal cerebral infarction.Methods From January 2002 to December 2010,44 newborn infants were diagnosed with cerebral infarction by imaging examinations at Peking University First Hospital.The neurodevelopmental outcomes of these newborn infants were followed up and evaluated by clinical manifestations,Gesell development scale,cranial imaging,electroencephalogram and auditory evoked potential.Factors related to prognosis were analyzed with single and multi-factor Logistic regression analysis.Results Thirty-eight (86％) cases were followed up,and of these cases,five children died and the results of three were inconclusive due to small age (less than 6 months old).Among the remaining 30 children,neurodevelopmental outcome was normal in 15 cases and abnormal in the remaining 15 cases,thus,the incidence of sequelae was 50％ (15/30) and the mortality rate was 13％ (5/38).Of the 15 abnormal cases,all had cerebral palsy and movement retardation,eight cases had cognitive impairment,eight cases had epilepsy and five had visual impairment.The incidence of large cerebral infarction (more than one lobe) was 14/15,worse cranial imaging outcome (one month after treatment,cerebral infarction lesion still present or had expanded)was 13/15,and severe complications was 8/15 in the newborns with sequelae,which were higher than in those without sequelae (4/15,5/15 and 1/15,respectively) (x2=13.889,8.889 and 7.778,all P＜0.05).Logistic regression analysis showed that large cerebral infarction was a risk factor for sequelae (OR=38.500,95％C1:3.749-395.407,P=0.002),however,worse cranial imaging outcome (OR=8.563,95％CI:0.909-80.683,P=0.061) and severe complications (OR=18.024,95％CI:0.516-630.163,P=0.111) were not risk factors for sequelae.Cerebral infarction with middle cerebral artery injury had a high risk of movement retardation (OR=6.000,95％CI:1.172-3.725,P=0.025),and those with a large cerebral infarction were more likely to have epilepsy (x2=7.273,P=0.010).The incidence of large cerebral infarction in the newborn infants with cognitive impairment was 8/8,which was much higher than in those without cognitive impairment (46％,10/22),thus,infarct area may be related to cognitive ability (x2=7.273,P=0.010).Conclusions Neonatal cerebral infarction might result in many types of sequelae,with motor impairment being the most common form.A large cerebral infarction is more likely to result in abnormal neurodevelopmental outcome.
ABSTRACT
Objective To compare the effects oflightwand(LW) and direct laryngoscope(DL) in elderly patients undergoing surgery on hemodynamics and stress responses.Methods Forty elderly patients with ASA grade Ⅰ-Ⅱ grade who selective surgery were divided into LW group and DL group by random digits table method,each group with 20 cases.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate(HR) were recorded respectively before intubation,30 seconds and 5 minutes after intubation.Extracted patients with peripheral arterial 3 ml at the same time,measured by radioimmunoassay epinephrine and norepinephrine levels.Results The SBP,DBP,HR,epinephrine,norepinephrine 30 seconds after intubation in LW group were significantly lower than those in DL group [(140.50 ± 21.91) mm Hg(1 mm Hg =0.133 kPa) vs.(167.95 ± 17.85) mm Hg,(67.80 ± 6.76) mm Hg vs.(84.15 ±9.89) mm Hg,(85.10 ± 11.76) times/min vs.(96.30 ± 13.72) times/min,(49.47 ± 8.09) ng/L vs.(61.25 ± 9.43) ng/L,(171.27 ± 17.11) ng/L vs.(187.40 ± 16.13) ng/L,P ＜ 0.01].The SBP,epinephrine,norepinephrine 5 minutes after intubation in LW group were significantly lower than those in DL group [(120.75 ± 17.12) mm Hg vs.(136.65 ± 15.43) mm Hg,(39.80 ±7.38) ng/L vs.(47.63 ±8.48) ng/L,(155.93 ± 17.11) ng/L vs.(172.76 ± 13.45) ng/L,P ＜ 0.01].Conclusion Both LW and DL can be well done in elderly patients intubation,but LW can reduce stress responses during the intubation.
ABSTRACT
Objective To explore risk factors of cerebral infarction in newborns by systematic reviews.Methods Case-control studies and case reports on risk factors of cerebral infarction in newborns from January 1997 to December 2011 were collected from database of CNKI,CQVIP,Wanfang Database,PubMed,OVID,Springer,Medline,Science Direct On Site,Besco and MD Consult.Meta analysis was performed on case-control studies with fixed or random effect model by Review Manager 5.0.Constitution ratio of risk factors of cerebral infarction in newborns in case reports was investigated.Results Two hundred and sixty-nine articles were found and among which,36 articles in English were selected for this study.Three case-control studies were found and adopted for meta analysis.Cumulative number of patients and control cases were 80 and 228,respectively.The pooled OR and 95 ％CI of selected factors were as follows:decreased fetal movement [7.10 (2.92-17.24)],abnormal fetal heart rate [4.45 (2.54-7.80)],vacuum delivery [2.99 (1.23-7.25)],resuscitation at birth [(3.14 (1.17-8.46)],premature rupture of membranes [2.40 (0.62-9.29)],cesarean section [2.64 (1.44-4.82)],preeclampsia [3.05 (1.44-6.43)],history of infertility [1.25 (0.18-8.67)],primiparous [1.79 (0.51-6.36)],oxytocin used [2.05 (0.99-4.25)],fetal growth restriction [0.99 (0.47-2.11)],meconium stained amniotic fluid [2.08 (0.94-4.58)],adverse pregnancy history [0.85 (0.43-1.68)] and breech presentation [0.38 (0.10-1.46)].Meta analysis showed that decreased fetal movement,abnormal fetal heart rate,vacuum extraction,resuscitation at birth,cesarean section and preeclampsia were risk factors of neonatal cerebral infarction.Decreased fetal movement,abnormal fetal heart rate and resuscitation at birth suggested that newborns suffered from perinatal hypoxia,vacuum extraction,cesarean section suggested abnormal delivery.It suggested that perinatal hypoxia and abnormal delivery were high risk factors of neonatal cerebral infarction.Among those factors,proportion of abnormal labor,fetal distress and hypercoagulabe state was 31.70％,21.13％ and 20.19％ respectively.Conclusions Abnormal birth,hypoxia,preeclampsia and hypercoagulation state might relate to neonatal cerebral infarction.
ABSTRACT
Objective To investigate the risk factors of cerebral infarction in newborns and to provide a theoretic basis for prevention.Methods From January 2002 to December 2010,8840 newborns were admitted into the Neonatology Department of Peking University First Hospital,among which 44 patients were diagnosed as cerebral infarction by review of brain imaging and medical records.These patients were taken as study group,and 175 patients were randomly selected as the control group matched by birthday and gestational age.Risk factors of neonatal cerebral infarction were analyzed by univariate analysis and binary Logistic regression.Results Of 27 352 infants born in Peking University First Hospital,21 infants were diagnosed as neonatal cerebral tnfarction,giving the prevalence of neonatal cerebral infarction of 7 per 10 000 live births (21/27 352).Of the 8840patients in Department of Neonatology,neonatal cerebral infarction accounts for 5.0‰ (44/8840).81.8％ (36/44) of the affected babies were delivered at term.The incidence of hypoxia and polycythemia in study group were 50.0％ (22/44) and 11.4％ (5/44),higher than those in control group [27.4％(48/175) and 2.9％(5/175)],differences were statistical significant (x2 =8.237,OR=2.646,95％CI:1.343-5.211,P=0.004; x2 =5.838,OR=4.359,95％CI:1.203-15.796,P=0.030).Logistic regression showed that hypertensive disorder complicating pregnancy (OR=3.388,95％CI:1.174-9.778,P=0.024),polycythemia (OR=4.319,95％CI:1.136-16.427,P=0.032)and hypoxia (OR =2.860,95％ CI:1.415-5.782,P =0.003) were risk factors for neonatal infarction.Further analysis suggested that the severity of hypoxia (x2 =- 3.470,P =0.001 ) and hypertensive disorder complicating pregnancy (x2=-2.074,P=0.038) had positive correlation with neonatal cerebral infarction.Conclusions Hypertensive disorder complicating pregnancy,polycythemia and hypoxia were risk factors of cerebral infarction,especially when preeclampsia and severe hypoxia occurred.
ABSTRACT
Objective To screen and identify differentially expressed genes in colorectal carcinoma and explore the possible molecular pathogenesis of colorectal carcinoma.Methods The differentially expressed cDNA bands in colorectal carcinoma specimens and matched adjacent normal tissues were isolated by fluorescent mRNA differential display.Following differential display PCR (DD-PCR),all cDNA fragments were sequenced.By using BLAST software,the sequencing results were compared with Genebank database for homologue analysis.RT-PCR was used to detect the expression of one of the differentially expressed genes in colorectal carcinoma samples were identified by semi-RT-PCR.Results BLAST analysis revealed that the cDNA band was homologous to DDX32 (99%) and its up-regulated expression in colorectal carcinoma tissues was confirmed by RT-PCR (P