Clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for severe MAS in neonates with meconium-stained amniotic fluid / 中国当代儿科杂志

OBJECTIVES@#To study the clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for the development of severe MAS in neonates with meconium-stained amniotic fluid (MSAF).@*METHODS@#A total of 295 neonates who were hospitalized due to Ⅲ° MSAF from January 2018 to December 2019 were enrolled as subjects. The neonates were classified to a non-MAS group (n=199), a mild/moderate MAS group (n=77), and a severe MAS group (n=19). A retrospective analysis was performed for general clinical data, blood gas parameters, infection indicators, and perinatal clinical data of the mother. The respiratory support regimens after birth were compared among the three groups. The receiver operating characteristic (ROC) curve and multivariate logistic regression analysis were used to investigate predicting factors for the development of severe MAS in neonates with MSAF.@*RESULTS@#Among the 295 neonates with MSAF, 32.5% (96/295) experienced MAS, among whom 20% (19/96) had severe MAS. Compared with the mild/moderate MAS group and the non-MAS group, the severe MAS group had a significantly lower 5-minute Apgar score (P<0.05) and a significantly higher blood lactate level in the umbilical artery (P<0.05). Compared with the non-MAS group, the severe MAS group had a significantly higher level of interleukin-6 (IL-6) in peripheral blood at 1 hour after birth (P<0.017). In the severe MAS group, 79% (15/19) of the neonates were born inactive, among whom 13 underwent meconium suctioning, and 100% of the neonates started to receive mechanical ventilation within 24 hours. Peripheral blood IL-6 >39.02 pg/mL and white blood cell count (WBC) >30.345×109/L at 1 hour after birth were early predicting indicators for severe MAS in neonates with MSAF (P<0.05).@*CONCLUSIONS@#Meconium suctioning cannot completely prevent the onset of severe MAS in neonates with MSAF. The neonates with severe MAS may develop severe respiratory distress and require mechanical ventilation early after birth. Close monitoring of blood lactate in the umbilical artery and peripheral blood IL-6 and WBC at 1 hour after birth may help with early prediction of the development and severity of MAS.

Impact of mild hypothermia therapy on hemodynamics during the induction stage in neonates with moderate to severe hypoxic-ischemic encephalopathy / 中国当代儿科杂志

OBJECTIVE@#To study the changes in hemodynamics during the induction stage of systemic mild hypothermia therapy in neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE).@*METHODS@#A total of 21 neonates with HIE who underwent systemic mild hypothermia therapy in the Department of Neonatology, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from July 2017 to April 2020 were enrolled. The rectal temperature of the neonates was lowered to 34℃ after 1-2 hours of induction and maintained at this level for 72 hours using a hypothermia blanket. The impedance method was used for noninvasive hemodynamic monitoring, and the changes in heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), cardiac index (CI), and total peripheral resistance (TPR) from the start of hypothermia induction to the achievement of target rectal temperature (34℃). Blood lactic acid (LAC) and resistance index (RI) of the middle cerebral artery were recorded simultaneously.@*RESULTS@#The 21 neonates with HIE had a mean gestational age of (39.6±1.1) weeks, a mean birth weight of (3 439±517) g, and a mean 5-minute Apgar score of 6.8±2.0. From the start of hypothermia induction to the achievement of target rectal temperature (34℃), there were significant reductions in HR, CO, and CI (@*CONCLUSIONS@#The systemic mild hypothermia therapy may have a significant impact on hemodynamics in neonates with moderate to severe HIE, and continuous hemodynamic monitoring is required during the treatment.

Consideration on Cultivation Mechanism of Clinical Medicine Postgraduates Based on Post Competency / 昆明医科大学学报

Objective To analyze the problems and reasons in the clinical medicine postgraduate cultivation.We stated the competency of clinical medicine postgraduates according to the transition of health demands global medical development and practical requirements for clinical personnel. Me thods Questionnaire surveys combined with interviews were conducted, and statistical analysis was performed. In the first part, we selected the permanent staff with qualifications of medical clinicians, including: chief physicians, associate chief physicians, physicians, residents, accounting for 72％ of the interviewees; And related personnel, including nurses, administrators and patients, were also interviewed, accounting for 28％ of the total. 90 questionnaires were distributed, and 86 valid questionnaires were recovered, with an effective rate of 95.56％. In the second part, graduate students with clinical professional degrees were selected for interviews, 96 questionnaires were distributed, and 92 valid questionnaires were collected, and the effective rate was 95.83％.Re s ults There was a certain gap between the expected goal and the actual situation of the post competency of clinical professional degree graduate students, and the gap had a certain statistical significance. The clinical professional degree graduate students paid more attention to the doctor-patient communication, teamwork. Conclus ions We elaborated the required post competence for clinical medicine postgraduates on the basis of its content and characteristic. We propose to strengthen the cultivation of clinical medicine postgraduates by the reform and support of the government enhanced construction of teachers improved course plan and cultivation process perfected assessment system in order to make the students competent to their posts.

Effects of garlicin on the expression of transcription factor T-bet and GATA-3 in blood lymph cells in rats with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of garlicin on the expression of transcription factors T-bet and GATA-3 in blood lymph cells of experimental rats with allergic rhinitis.</p><p><b>METHODS</b>Thirty healthy SD rats were randomly divided into 3 groups, with 10 rats for each. Ten rats (pharmacological group) were sensitized and intranasally challenged by ovalbumin (OVA), aluminium hydroxide hydrate gel and Bordetella pertussis (B. pertussis) inactive microorganism suspension adjuvants, as the allergic rhinitis models, and then injection of garlicin (0.4 ml) intraperitoneally per day for 10 days. Ten rats in the control group were immunized as the pharmacological group, and then injection of physiological saline as equal volume as garlicin. Ten rats in the negative control group were investigated using physiological saline only. Plasma and lymph cells were separated from 2 ml blood which was extracted from rat heart. Enzyme linked immunosorbent assay (ELISA) was utilized to detect the levels of plasma IL-4 and IFN-γ, and RT-PCR was utilized to detect the expression of T-bet and GATA-3.</p><p><b>RESULTS</b>The levels of IL-4 (x(-) ± s) were (6.292 ± 1.734), (14.252 ± 1.971), (4.916 ± 0.600) pg/ml, respectively, and the levels of IFN-γ were (24.338 ± 2.375), (12.364 ± 1.749), (16.136 ± 2.012) pg/ml, respectively, among the pharmacological, control and negative control groups. The plasma level of IL-4 in the pharmacological group rats was lower than that of control group rats (t = 4.23, P < 0.05), while there was no significant difference between the pharmacological and negative control group rats (t = 1.01, P > 0.05). The plasma level of IFN-γ was increased significantly in the pharmacological group rats when compared with the value of control group rats (t = 4.61, P < 0.05) and with the negative control group (t = 5.79, P < 0.05), respectively. There was no significant difference (t = 1.17, P > 0.05) in plasma level of IFN-γ in the control group rats when compared with the negative control group. Relative quantization of expression of GATA-3 (median) was 0.826, 1.029 and 0.474, and those of T-bet (median) were 1.245, 0.280 and 0.544, respectively, among the pharmacological, control and negative control groups. There were significant difference among 3 groups (chi² = 6.599, P = 0.019; chi² = 9.884, P = 0.007, respectively). Relative quantization of expression of GATA-3 in the control group rats was significantly higher than that in the negative control group and pharmacological group rats (chi² value were 10.113 and 2.384, respectively, all P < 0.05), and that of GATA-3 in the pharmacological group rats was increased as compared to the negative control group rats (chi² = 3.784, P < 0.05). The level of expression of T-bet in pharmacological group rats was elevated markedly with a significant difference as compared to both control (chi² = 16.021, P < 0.05) and negative control groups (chi² = 14.103, P < 0.05).</p><p><b>CONCLUSIONS</b>Garlicin may upregulate the expression of T-bet dramatically and downregulate the expression of transcription factor GATA-3 in the experimental models of allergic rhinitis.</p>

Pathologic changes of palatopharyngeal muscle in patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the pathologic changes of the palatopharyngeal muscles in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), the role of the above muscles in OSAHS pathogenesis was discussed.</p><p><b>METHODS</b>Thirty OSAHS patients receiving uvulopalatopharyngoplasty selected, and ten normal subjects without snoring as the control group. The successive longitudinal sections of palatopharyngeal muscle were stained for observing Troponin-I's content. All specimens were examined with transmission electronmicroscopy (TEM) and light microscopy.</p><p><b>RESULTS</b>Twenty nine of 30 specimens obtained from OSAHS patients evaluated with TEM showed pathologic changes of different degrees. While 2 among 10 specimens in control group showed mild myofibril edema or hypertrophy, no pathologic changes shown in other specimens. Immunohistochemistrial results of all specimens sections stained for observing Troponin-I antibody have shown that negative grey degree value is 146.30 +/- 10.72 in study group and 107.50 +/- 4.81 in control group respectively. There is significant difference between these two groups (P < 0.05). The negative grey degree value of study groupl and study group2 are 143.12 and 148.80 respectively , no statistical difference (P > 0.05).</p><p><b>CONCLUSIONS</b>Palatopharyngeal myelofibrosis may affect pharyngeal dilator muscles function, this could be one mechanism of upper airway collapsibility.</p>

Expression of two kinds of tumor correlation protein in laryngeal carcinoma and precancerous lesions / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the expression of S phase kinase associated protein 2 (Skp2), phosphatase and tensin homolog deleted on chromosome ten (PTEN) in human laryngeal carcinoma and precancerous lesions, to explore their relations and clinical significance.</p><p><b>METHODS</b>Formalin-fixed and paraffin-embedded tissues from 79 cases of laryngeal carcinoma, 16 cases of atypical hyperplasia of vocal fold,14 cases of adult laryngeal papillomas and 27 cases of vocal cord polyps were evaluated for the expression of Skp2, PTEN by SP immunohistochemistry, the levels of these proteins in tissues with the different types of lesion and their correlation with clinicopathological parameters of laryngeal carcinoma were analyzed.</p><p><b>RESULTS</b>The expression rates of Skp2 in vocal cord polyps, adult laryngeal papillomas, atypical hyperplasia of vocal cord and laryngeal carcinoma were 11. 11% ,14. 29% ,37. 50% ,39. 24% respectively. There was significant difference among them( Hc = 11. 57, P <0. 01). The expression rates of PTEN protein in vocal cord polyps,adult laryngeal papillomas, atypical hyperplasia of vocal cord and laryngeal carcinoma were 100% ,92. 86% ,75. 00%, 56. 96% respectively . There was significant difference among them (Hc = 62. 86, P<0. 05). There was a negative correlation between the expression of Skp2 and PTEN,and their correlation coefficient was r = -0. 4512(P <0. 01). Patients with Skp2 expression in laryngeal carcinoma revealed poorer five yeas survival rate than patients with negative expression of Skp2 (x2 = 21. 46, P = 0. 000).</p><p><b>CONCLUSIONS</b>The expression of Skp2 and PTEN took important roles in the tumorigenesis, aggressiveness, metastases of laryngeal carcinoma. The high expression of Skp2 was negative correlation with the lower PTEN in laryngeal carcinoma, which suggested that PTEN may regulate the expression of Skp2.</p>