Concentrations of Polybrominated Diphenyl Ethers in Maternal Blood, Placental Size, and Risk for Fetal Growth Restriction: A Nested Case-control Study / 生物医学与环境科学（英文）

Objective@#To explore the effects of prenatal exposure to polybrominated diphenyl ethers (PBDEs) on placental size and birth outcomes.@*Methods@#Based on the perspective Wenzhou Birth Cohort, this nested case-control study included 101 fetal growth restriction (FGR) and 101 healthy newborns. Maternal serum samples were collected during the third trimester and measured for PBDEs by gas chromatography tandem mass spectrometry. The basic information of mother-newborn pairs was collected from questionnaires, whereas the placental size and birth outcomes of newborns were obtained from hospital records.@*Results@#A total of 19 brominated diphenyle ether (BDE) congeners were detected in maternal serum samples. Higher concentrations of BDE-207, -208, -209, and ∑ @*Conclusion@#A negative association was found between PBDE levels in maternal serum and placental size and birth outcomes. Prenatal PBDE exposure may be associated with elevated risk of the incidence of FGR birth.

Brief introduction of the pediatric residency and neonatal-perinatal medicine fellowship standardized training system in the United States / 中国实用儿科杂志

Medical education after graduation is the necessary step for each medical graduate to become an independent practitioner. The present medical education system or standardized residency training system in China is similar to that of the United States and Canada. This system is designed to ensure that all trained physicians are competent in practicing medicine in their trained medical specialties. The article briefly summarizes the current status of the pediatric residency and neonatal-perinatal medicine fellowship training system in the United States. The critical roles of the American Board of Pediatrics and the Accreditation Council for Graduate Medical Education are also presented.

Ellagic acid attenuates hypoxic-ischemic brain injury by alleviating autophagy / 中国病理生理杂志

AIM:To investigate whether ellagic acid (EA) attenuates hypoxic-ischemic encephalopathy (HIE) by down-regulating autophagy.METHODS:In vivo, Sprague-Dawley rats (n=17) were randomly divided into 3groups:5 rats for sham group, 6 rats for HIE group and 6 rats for HIE+EA pretreatment group.The rats in HIE+EA pretreatment group were treated with EA (10 mg/kg, 10 m L/kg, suspended in corn oil, ig).After 24 h of operation, the rats from each group were sacrificed and their brains were collected.TTC staining and HE staining were used to define the infarct areas and brain structure.The autophagy-related proteins beclin-1, P62, LC3-II/-I and Atg5 in the cortex in each group were compared by Western blot.In vitro, PC12 cells were divided into 3 groups:control group, Coand CoEA pretreatment group.Co800μmol/L was added to the PC12 cells to induce an anoxic environment.The PC12 cells were pretreated with EA at 8μmol/L and the cell viability was measured by CCK-8 assay.The production of reactive oxidative species (ROS) in the cells was detected by flow cytometry with DCFH-DA staining.MDC staining and TM-RE staining were applied to reflect the extent of autophagy and the state of apoptosis, respectively.The autophagy-related proteins in PC12 cells were also investigated.RESULTS:In HIE group, 7-day-old rats were given the operations and the their large infarct areas in the hemisphere were observed by TTC staining.HE staining displayed the injured hemispheres which contained few neurons, and exhibited edema status and serious structural damage.EA pretreatment decreased the infarct area and alleviated the damage to hemisphere with more visible neurons, compared with HIE group.Compared with sham group, the levels of autophagy-related proteins Atg5, beclin-1 and LC3-II/-I in the cortex were increased (P<0.01) , and P62 protein expression was decreased (P<0.01) in HIE group.Compared with HIE group, the protein expression of Atg5, beclin-1 and LC3-II/-I was decreased (P<0.01) and P62 protein expression was increased in HIE+EA pretreatment group (P<0.01).In vitro, compared with CoPC12 cells in CoEA pretreatment group showed a lower ROS level.Moreover, the cells in CoEA pretreatment group exhibited higher mitochondrial membrane potential than that in CoMDC staining in Coshowed high value of fluorescence and increased number of autophagosomes.EA pretreatment reduced the number of autophagosomes and the extent of autophagy to protect PC12cells.Furthermore, the protein levels of Atg5, beclin-1 and LC3-II/-I in Cowere higher (P<0.01) , and the protein expression of P62 was lower (P<0.01) than those in control group.In CoEA pretreatment group, the protein levels of Atg5, beclin-1 and LC3-II/-I were decreased (P<0.01) and the protein expression of P62 was increased as compared with Co (P<0.01).CONCLUSION:EA pretreatment attenuates autophagy to protect the neurons against HIE injury.

Investigation and analysis of nosocomial infection in neonates / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the incidence of nosocomial infections of newborn infants in neonates and to explore the risk factors and strategies of infection control.</p><p><b>METHODS</b>There were 433 confirmed cases of nosocomial infection in the neonatal ward of the authors' hospital from January 2007 to December 2009. Their data of epidemiological and clinical characteristics, results of etiological examinations and antibiotic resistance were retrospectively analyzed.</p><p><b>RESULTS</b>During the study, the number of hospitalizations were 6437. Nosocomial infection occurred in 433 patients 513 times. The overall nosocomial infection rate was 6.82%. The overall hospitalization days were 73 663 and nosocomial infection patient-day rates were 6.96‰. The VAP infection rate was 28.7‰. The CRBSI rate was 3.5‰. Gestational age (OR = 1.049), mechanical ventilation (OR = 1.810), umbilical vein catheter (OR = 1.106), hospitalization days (OR = 1.081), premature rupture of membrane (OR = 1.433) were the risk factors for the development of nosocomial infection. There were 197 (38.4%) cases of pneumonia, which was the most common nosocomial infection in Neonatal Ward. There were 129 cases of ventilator-associated pneumonia (VAP), which accounts for 65.5% of pneumonia and 24.4% of cases treated with ventilator. The next was sepsis, 124 cases (24.2%) and 64 cases of diarrheal disease (12.7%). One hundred and eighty two (54.4%) strains of isolates were Gram-negative bacteria, which accounted for the highest proportion. The predominant pathogens of Gram-negative bacteria were Klebsiella pneumoniae (19.6%), followed by Acinetobacter baumannii (8.1%), Pseudomonas aeruginosa (7.2%), Stenotrophomonas maltophilia (4.8%) and Escherichia coli (4.8%). The isolation rates of Klebsiella pneumoniae and Escherichia coli with positive extended-spectrum beta-lactamases (ESBLs) were 91.4% and 75%, respectively. Those two bacteria were universally resistant to cephalosporins. The rate of resistance to imipenem of Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa were 1.5%, 11.1% and 41.7%. The isolation rates of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus were 28.6% and 95.5%.</p><p><b>CONCLUSION</b>It is important to identify the high risk factors for nosocomial infections in newborn infants. To shorten time for mechanical ventilation and hospitalization days, removal of the central venous catheter as early as possible would be conducive to reducing the morbidity of nosocomial infection. The main pathogens were Gram-negative bacteria. The multidrug resistance of Enterobacteriaceae and Non-fermenters is serious.</p>

Risk factors for ventilator-associated pneumonia in neonates and the changes of isolated pathogens / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the risk factors for neonatal ventilator-associated pneumonia (VAP) and the changes of isolated pathogens in the last eight years.</p><p><b>METHODS</b>The clinical data of 230 neonates who were admitted into the neonatal intensive care unit (NICU) and received mechanical ventilation for equal to or longer than 48 hrs in 2008 were retrospectively reviewed. The isolated pathogens were compared with those of eight years ago.</p><p><b>RESULTS</b>The incidence of VAP (25.2%) in the year 2008 was lower than that of eight years ago (36.1%; P<0.05). The development of VAP was negatively correlated with the gestational age and the birth weight, but positively correlated with the duration of mechanical ventilation, intubation times, duration of hospitalization, presence of gastrointestinal bleeding and need for blood products transfusion. The main isolated pathogens were opportunistic antibiotics resistant bacteria, and the majority was gram negative bacilli (77%). The most frequently detected gram negative bacilli were Klebsiella (20%), Stenotrophomonas maltophilia (18%) and Acinetobacter (13%). Streptococcus mitis was the most frequently detected gram positive bacilli (14%). The distribution pattern of pathogens isolated in the same NICU eight years ago was somewhat different: Klebsiella (23%), Pseudomonas aeruginosa (17%), Acinetobacter (16%), Streptococcus mitis (11%), Fungi (1%) and Candida albicans (1%).</p><p><b>CONCLUSIONS</b>The incidence of VAP is correlated with gestational age, birth weight, duration of mechanical ventilation and hospitalization, intubation times, presence of gastrointestinal bleeding and need for blood products transfusion. The main isolated pathogens are usually antibiotic resistant opportunistic bacteria. The detection rate of Stenotrophomonas maltophilia increased and that of Pseudomonas aeruginosa decreased when compared with eight years ago.</p>

Role of Ommaya reservoir in the management of neonates with post-hemorrhagic hydrocephalus / 中华儿科杂志

<p><b>OBJECTIVE</b>Intra-ventricular hemorrhage (IVH) is one of the most serious complications of preterm infants. Significant numbers of the surviving infants with severe IVH go on to develop post-hemorrhagic hydrocephalus (PHH). The management of PHH remains a very challenging problem for both neonatologists and pediatric neurosurgeons. This study aimed to evaluate the efficacy and safety of the use of Ommaya reservoirs and serial cerebrospinal fluid (CSF) drainage in the management of a series of neonates with PHH.</p><p><b>METHOD</b>Between January 1, 2003 and December 30, 2005, 15 consecutive newborn infants with IVH grades III to IV, complicated with progressive ventricular dilatation, underwent placement of an Ommaya reservoir. CSF was intermittently aspirated percutaneously from the reservoir. The amount and frequency of CSF aspiration were based on the clinical presentation and the follow-up results of serial cranial ultrasonograms or CT scans. The changes of CSF cell counts and chemistries were also followed. Patients whose progressive ventricular dilatation persisted despite serial CSF aspiration through Ommaya reservoir eventually had ventriculo-peritoneal shunts (V-P shunt) placed. All the patients were followed up in the outpatient clinic after discharge from the hospital and the neurodevelopmental outcomes were evaluated through 18-36 months of age.</p><p><b>RESULT</b>A total of 15 infants were included in this series. Of them, 11 were preterm infants who were at gestational ages of 29 to 34 weeks and 4 infants were full-term. All of the 4 full term infants presented with progressive ventricular dilatation after suffering from the intra-cranial hemorrhage (3 infants were due to vitamin K deficiency and 1 was due to birth trauma). Thirteen infants had grade III IVH, and 2 had grade IV IVH based on initial cranial ultrasonographic and CT scans. The mean age when IVH was diagnosed was (9 +/- 1) days in preterm infants and (22 +/- 7) days in full-term infants; the mean age when Ommaya reservoir was placed was (18 +/- 11) days in preterm infants and (31 +/- 7) days in full-term infants. All the infants tolerated the surgical procedure well. The Ommaya reservoir was tapped for an average of (21.5 +/- 4.6) times per patient. The mean CSF volume per tap was (10.2 +/- 1.3) ml/kg. The values of CSF protein, glucose and cell counts slowly reached normal levels at approximately 3 - 5 weeks after the placement of the reservoir. The velocity of head circumference increase per week was less than 1 cm in 13 patients in 1 - 4 weeks after the placement of the reservoir and the size of ventricles decreased gradually. By 12 - 18 months, 12 infants had normal size ventricles, and 1 patient still had mild ventricular dilation at 36 months. Two infants developed progressive hydrocephalus after serial CSF aspiration through Ommaya reservoir. One infant had a V-P shunt placed at 2 months of age and another infant died at 3 months of age at home after parents refused further therapy. Complications consisted of reservoir leaking and CSF infection at 16th day of placement in one patient after repeated tapping. By the end of 18 - 36 months of follow-up, 11 of 14 infants were considered normal, two patients had mild impairment in neurodevelopmental outcome (both had spastic bilateral lower limbs paresis, and one of whom also had amblyopia) and the other had seizure disorder.</p><p><b>CONCLUSION</b>The results from this series indicate that the placement of an Ommaya reservoir is relatively safe in newborn infants and is useful in the initial management of neonates with PHH and may be beneficial in improving their neurodevelopmental outcomes. A multicenter randomized trial may be needed to further validate the results of this report.</p>