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Objective:To investigate the role of neutrophil CD 11b (nCD 11b), soluble CD 14 subtype (sCD 14-St) and mitochondrial coupling factor-6 (CF-6) in the risk stratification of disease outcome in neonatal sepsis and its clinical significance. Methods:The clinical data of 121 septic neonates from July 2019 to March 2020 in Shanxi Children′s Hospital were retrospectively analyzed. According to the neonatal critical illness score (NCIS), the neonates were divided into non-critical group (NCIS>90 scores) with 35 cases, critical group (NCIS 70 to 90 scores) with 49 cases, very critical group (NCIS<70 scores) with 37 cases. There were 25 cases with poor prognosis (death), and 96 cases with good prognosis (survival). The C-reactive protein (CRP), procalcitonin (PCT), nCD 11b, sCD 14-St and CF-6 before treatment were detected. The correlation between nCD 11b, sCD 14-St, CF-6 and disease severity was analyzed by Spearman method; the value of nCD 11b, sCD 14-St and CF-6 in predicting poor disease outcome in sepsis neonates was analyzed by the receiver operating characteristic (ROC) curve. Results:The nCD 11b, sCD 14-St, CF-6, PCT and CRP in critical group and very critical group were significantly higher than those in non-critical group: (414.68 ± 93.29) and (532.74 ± 101.85) MFI vs. (325.45 ± 71.90) MFI, (892.40 ± 113.72) and (1 249.53 ± 95.41) ng/L vs. (784.66 ± 103.72) ng/L, (84.79 ± 28.35) and (121.66 ± 34.27) ng/L vs. (42.59 ± 13.51) ng/L, (19.24 ± 6.30) and (34.96 ± 11.95) μg/L vs. (8.89 ± 2.24) μg/L, (109.49 ± 36.77) and (247.13 ± 82.06) mg/L vs. (56.84 ± 17.25) mg/L; the indexes in very critical group were significantly higher than those in critical group, and there were statistical differences ( P<0.05). Spearman correlation analysis result showed that nCD 11b, sCD 14-St and CF-6 were positively correlated with disease severity in sepsis neonates ( r = 0.719, 0.813 and 0.823; P<0.01). The nCD 11b, sCD 14-St, CF-6, PCT and CRP in poor prognosis neonates were significantly higher than those in good prognosis neonates: (618.58 ± 146.92) MFI vs. (374.55 ± 120.03) MFI, (1 516.91 ± 194.38) ng/L vs. (828.13 ± 175.67) ng/L, (165.84 ± 25.63) ng/L vs. (62.51 ± 16.75) ng/L, (43.46 ± 10.14) μg/L vs. (20.19 ± 6.30) μg/L and (321.09 ± 94.56) mg/L vs. (88.24 ± 29.19) mg/L, and there were statistical differences ( P<0.01). ROC curve analysis result showed that the area under the curve (AUC) of nCD 11b, sCD 14-St and CF-6 for predicting poor disease outcome in sepsis neonates were 0.763, 0.796 and 0.838 (95% CI 0.678 to 0.836, 0.713 to 0.864 and 0.760 to 0.899), and the AUC of combination the 2 indexes was 0.921 (95% CI 0.858 to 0.962). Conclusions:The nCD 11b, sCD 14-St and CF-6 are associated with the disease severity and prognosis in sepsis neonates, and can be used as markers for risk stratification of disease outcome and assessment prognosis.
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Objective To study the effect of renal p53 protein expression on kidney development in rats with intrauterine growth restriction ( IUGR) . Methods Pregnant rats were randomly assigned into normal group, IUGR group and L-Arg treated group. Normal group were fed with normal diet (21％protein). IUGR group and L-Arg treated group were fed with low-protein diet (10％ protein). During lactation, maternal rats in the three groups were all fed with normal diet. Maternal rats in L-Arg treated group were given additional special drinking water ( L-Arg:200 mg/kg) , while maternal rats in normal and IUGR group were given normal drinking water. Offspring weaned after 21 d and had free access to normal rodent diet and water. When the pups grew up to 2 m, the number of glomeruli was counted using acid digestion method, the proliferation and apoptosis of glomerular and tubular cells were studied using TUNEL and Ki-67 immunohistochemistry, and the ultrastructure of epithelial cells was determined by electron microscopy. At 7 d, 21 d, 2 m and 3 m, p53 protein expression in renal tissue was measured by Western blot, respectively. Results At 2 m, the number of glomerulus ( right kidney) in IUGR group was significantly lower than normal group [(23 647±541) vs. (27 689±492), P＜0. 01]; the index of renal cell apoptosis in IUGR group was higher than normal group [(21. 9 ± 2. 0) vs. (16. 7 ± 2. 5), P＜0. 05];however, IUGR group and normal group had no statistically significant difference (P＞0. 05). The proliferation of mesangial cells was found in IUGR and L-Arg treated group, but not in normal group. And the extent of proliferation in L-Arg treated group was lesser than IUGR group. A reduction of foot process and partial fusion of foot process could be observed in IUGR group and L-Arg treated group while the foot process morphology in normal group was normal. At 2 m and 3 m, p53 protein level in IUGR group and L-Arg treated group were higher than normal group [ 2 m: ( 0. 28 ± 0. 03 ) and ( 0. 21 ± 0. 01 ) vs. (0. 10±0. 02);3 m:(0. 39±0. 04) and (0. 26±0. 02) vs. (0. 17±0. 03);P＜0. 01], while IUGR group higher than L-Arg treated group ( P＜0. 05 ) . Conclusions The kidney of IUGR rats showed reduced glomerular number, increased renal cell apoptosis, enhanced p53 protein expression, increased proliferation of glomerular mesangial cells, decreased foot process, and partial fusion of foot process. And L-Arg could to some extent improve the organizational structure of the kidney in IUGR rats.
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Objective To investigate the effect of p53-gene expression on renal function in rat with low birth weight ( LBW) .Methods Fifteen pregnant rats were randomly assigned into normal group, LBW group, and L-arginine ( L-Arg)-treated group.For normal group, pregnant rats were fed with 21% protein diet during pregnancy.For LBW and L-Arg treated groups, rats were fed with 10%protein diet.After de-livery, all rats were fed with 21%protein diet.For L-Arg-treated group, rats were given a supplementation with L-Arg (200 mg/kg) drinking water during 21 d lactation, other rats were given running water.At the age of 2m, the ultrastructural change in mesangial cell and podocyte was observed with electron microscope. At the age of 7 d, 21 d, 2 m, and 3 m old, the p53 mRNA expression in renal tissues was observed with re-verse transcription polymerase chain reaction ( RT-PCR) , blood and urine were collected to detect biochem-ical indicators of renal function and 24 h-urine protein.Results ⑴At the age of 3 m,the blood urea nitro-gen ( BUN) and urine cretinine ( UCr) in normal group were significantly lower than those in LBW group ( P <0.01).Compared to normal group, the Ucr of LBW group was significantly lower at the age of 2 m ( P<0.05).At the age of 3 m,the Ucr of L-Arg treated group and LBW group was significantly lower ( P <0.05), the level of 24 h-Urine protein was notably increased in LBW group and L-Arg treated group than that in normal group ( P <0.01, P <0.05) .⑵At the age of 3 m,the expression of p53 mRNA in LBW group was higher obviously than that in normal group.There is a significantly negative correlation between the expression of p53 mRNA and the level of Ucr in LBW group ( r =-0.91, P <0.05).⑶ There were mesangial cell proliferation with matrix increase, filtration membrane podocyte reduction, and partially dis-solved in LBW group, the mesangial cell proliferation of L-Arg treated group was decreased compared to that in LBW group.Conclusions The higher expression of p53 gene in LBW group might be one of reasons for the decreased renal function in LBW rats.
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Objectives To investigate the effect and mechanism of terbutaline sulfate on pulmonary fluid transport in pre-mature rats. Methods Pregnant rats were randomly divided into 5 groups (control group, premature group, low-dose terbutaline group, high-dose terbutaline group and dexamethasone group). Drugs were administered by gavage after rats were fertilized for 16 days and continued for 3 days. Premature rats were taken out from the 19 days pregnant rats, and mature rats were delivered on the due day. Lungs were collected, and the ratio of pulmonary wet weight to dry weight (W/D), Na+, K+-ATP ase activity and concentration of cyclic adenosine monophosphate (cAMP) were measured in lungs. Results The W/D rate, Na+,K+-ATPase acti-vity and cAMP concentration in lungs had significant difference among different groups (P<0.01). The W/D rate was highest in premature group and lowest in the control group. It was lower in the high-dose terbutaline group than in the low-dose terbutaline group and the dexamethasone group (P<0.05). The Na+,K+-ATPase activity was lowest in premature group and highest in high-dose terbutaline group. It was higher in dexamethasone group, low-dose terbutaline group, and high-dose terbutaline group than in premature group, and it was higher in high-dsoe terbutaline group than in low-dose terbutaline group and dexamethasone group (P<0.05). The cAMP levle was lowest in premature group and highest in high-dose terbutaline group. It was higher in dexamethasone group, low-dose terbutaline group, high-dose terbutaline group than in premature group, and it was higher in high-dose terbutaline group than in low-dose terbutaline group and dexamethasone group (P<0.05). Conclusions Terbutaline sulfate facilitates lung fluid transport in premature rats, leading to reduce the W/D rate in terbutaline-treated group. We speculate that this effect is related to the increased cAMP level and Na+, K+-ATPase activity in lung tissue.
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Objective To explore the effect of early application of pediauic amino acids on extrauterine growth and development of preterm and small for gestational age infants.Methods A total of 106preterm and small for gestational age infants was selected in our NICU from June 2011 to May 2013,and randomly divided into two groups:treatment group (group T) and control group (group C).Next,each group was divided into two subgroups according to gestational age and birth weight.Such as ≥34W group (group T1,group C1),＜ 34W group (group T2,group C2),＜ 1.5 kg group (group T3,group C3) and ≥ 1.5 kg group (group T4,group C4).They were observed the effect of extrauterine growth and correlative serum biochemical indicators with application of pediatric amino acid in postnatal 6 hours and 12 hours.Resuits After 2-week treatment,the head circumference and weight growth of group T were higher than that of group C (P ＜ 0.05,or P ＜ 0.01),and the time of birth weight recovery was significantly shortened(P ＜ 0.05,or P ＜ 0.01).The incidence rate of extrauterine growth retardation(EUGR) in the group T was lower than that in group C,there is significantly statistical differences(P ＜ 0.01).The concentration of blood urea nitrogen (BUN) in group T was obviously increased than that in the group C(P ＜0.01).The levels of ALT,aspartate aminotransferase (AST),total bilirubin (TBIL),cholesterol (CH) and triglycerides (TG) were not different between the group T and group C.The comparison of alanine aminotransferase (ALT) levels were statistically significant between group C4 and group T4.In the different gestational age groups,the concentration of BUN in group T was obviously higher than that in the group C after 2-week treatment(P ＜0.05),the levels of AST,TBIL,CH and TG were not different between the group T and group C (P ＞ 0.05).The incidence rate of EUGR in the 4th group C was increased significantly than that in the 4th group T(P ＜0.05).Conclusions The preterm and small for gestational age infants were safe after the pediatric amino acid was used at the 6 h after birth.Amino acid can promote growth of head circumference and weight,shorten the birth weight recovery time and reduce the incidence of EUGR.
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Community health service in the new century has entered a new stage of development. To ensure the healthy advancement of community health service in the course of system building, the following guiding principles must be adhered to: spurring on system innovation with concept innovation and giving full play to the staying power of community health service; taking the introduction of the competition mechanism as the soul and unremitting impetus of innovation; persisting in the solution of problems accompanying advance and development with methods promoting development; taking the strategic readjustment of health resources as the main line of development; taking the attainment of a favorable external environment as the impetus of development; and sticking to a path of coordinated growth that stresses both quality and speed.
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The paper first offers a comprehensive analysis of the current situation of and contradictions in community health service in China and then, in view of the major problems, puts forward the view of improving the mechanism of community health service with reform as an impetus. The chief steps to be taken include: strengthening confidence, clarifying orientation and bringing into play the primary, comprehensive and preventive role of community health service; taking advantage of the current “founding activities” to deepen the reform and construction of community health service; focusing on the priorities and speeding up the cultivation of the contingent of talents; and perfecting as soon as possible the policy of setting quotas for subsidies to community health service and promoting in an all-round way community health service development.
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A nationwide pilot project concerning community health sendees, the major part and chief link of the reform in the urban medical health system, has basically come to an end. The author expounds against the background of reform in the health system in China the motives and orientation of reform in the medical health system and the current situation of and problems in the development of community health services. It is pointed out that advancing community health services entails all of the following:①genuinely transforming concepts and seeking unity of thinking; ②adopting the mechanism of competition and enhancing the sense of innovation; ③persisting in keeping abreast of the times and laying emphasis on reform and development;④accelerating the readjustment of resources and optimizing resource allocation; ⑤ceating a sound environment and seeking common development; ⑥giving priority to the improvement of quality and avoiding superficial transformation.