ABSTRACT
Objective To study the distribution of preterm infants' body temperature at admission and its effects on the clinical outcome.Method The distribution of preterm infants' body temperature at admission and its effects on their clinical outcome were searched in the Cochrane library,PubMed,Embase,Wanfang,CNKI,VIP from the initial establishment of these databases to June 2018.The quality of the included studies were assessed.STATA 12.0 software was used for statistical analysis.The odds ratio (OR) and 95％ confidence interval(CI) were used for continuous variables.Result A total of 16 studies (including 15 clinical trials) with 47 113 cases were included.The incidences of different admission temperatures were as follows:＜35℃:10.3％ (7.6％～13.1％),＜36℃:45.3％ (35.0％～55.5％),＜36.5℃:63.5％ (51.8％～75.2％),36.5～37.4℃:35.1％ (25.6％～44.7％),≥37.5℃:4.2％ (2.6％～5.7％).Compared with normothermia (36.5～37.4℃),hypothermia (＜35℃,35～35.9℃,36～36.4℃) increased the mortality,with the OR and 95％CI as follows:6.10(4.88～7.62),1.96(1.45～2.66),1.31(1.16～1.48);hyperthermia (≥37.5℃) was not associated with higher mortality (OR =0.98,95％CI 0.73～1.32,P=0.91).Compared with normothermia (36.5～37.4℃),hypothermia (＜36℃) increased the risks of severe retinopathy of prematurity (ROP),necrotizing enterocolitis (NEC),sepsis,periventricular leukomalacia (PVL) and intraventricular hemorrhage (IVH),with the OR and 95％CI as follows:ROP:1.70(1.45～2.00),NEC:1.27(1.08～1.49),sepsis:1.44(1.28～ 1.61),PVL/IVH:1.26(1.07～1.48),but not the risk of bronchopulmonary dysplasia (BPD,OR =1.03,95％CI 0.76～1.38,P=-0.87).Compared with normothermia (36.5～37.4℃),the temperature between 36～36.4℃ did not increase the risk of severe ROP,NEC,BPD,sepsis,PVL/IVH,with the OR and 95％CI as follows:1.19(0.92～ 1.54),1.01(0.86～1.18),0.91(0.68～1.22),1.02(0.91～1.14),0.98(0.85～1.14).Conclusion Admission temperature of ＜35℃,35～35.9℃,and 36～36.4℃ increased the mortality risk compared with 36.5～37.4℃,and the lower admission temperature,the higher mortality risk.Admission hypothermia (＜36℃) increased the risk of severe ROP,NEC,sepsis,PVL/IVH compared with normothermia (36.5～37.4℃).
ABSTRACT
Objective To systematically evaluate the effectiveness of delayed cord clamping (DCC) in term infants. Methods The data of the Cochrane library, PubMed, EMBASE, CNKI , VIP, Wanfang from 1 January 1970 to 30 April 2013 were searched. Randomized controlled trials (RCT) of DCC in term infants were included.RevMan 5.1.0 was used in the statis-tical analysis. Results Ten studies involving 1623 participants were included. Meta-analysis based on included studies showed that:compared with immediate cord clamping (ICC), DCC improved the hemoglobin levels at birth (MD=2.19, 95%CI:0.36, 4.02) and increased the incidence of polycythaemia (RR=2.87, 95%CI:1.24, 6.62). Compared with ICC, DCC showed no signi-ficant difference in the phototherapy for hyperbilirubinemia (RR=2.46, 95%CI: 0.93, 6.52), the hemoglobin levels within 6 months (MD=0.29, 95%CI:-0.17, 0.75), and the incidence of anemia (RR=0.71, 95%CI:0.45, 1.12). Conclusions DCC can improve the hemoglobin level in term infants after birth. However, the appropriate time of cord clamping has not been deter-mined. It is necessary to undertake further studies with higher quality and larger scale to evaluate the optimal time of cord clam-ping.
ABSTRACT
Objective To explore the mechanism of intrauterine growth restriction (IUGR) via observing the change of mitochondria in IUGR placenta. Methods Placenta samples were collected from 30 singleton pregnancies at the time of elec-tive caesarean section. Fifteen of them were appropriate for gestational age and 15 were IUGR. Mitochondrial morphology was observed by transmission electron microscopy, DNA copies were analyzed by real-time quantitative PCR and membrane potential was assayed by lfow cytometry. Results Signiifcant morphological changes of placental mitochondria were observed under transmission electron microscopy in IUGR, mitochondrial DNA copies in IUGR placenta were signiifcantly increased (P<0.01) and membrane potential decreased dramatically (P<0.01). Conclusions It is suggest that impaired mitochondrial function in IUGR may involve in IUGR pathogenesis.
ABSTRACT
Objective To evaluate the effects of delayed cord clamping (DCC) on preterm infants with gestational age ＜32 weeks.Methods Literatures from January 1,1990 to April 30,2013 in Cochrane library,PubMed,EMBASE,China Academic Journal Network Publishing Database,Wanfang Medical Database and VIP Database were searched.Randomized controlled trials (RCT) of DCC in preterm infants with gestational age ＜32 weeks were screened and evaluated.DCC was defined as cord clamping in 30-90 s after delivery,and early cord clamping (ECC) (＜30 s) was as the control.Rev Man 5.1.0 was used for statistical analysis.Mean difference (MD) and 95％CI were used for continuous data while OR and 95％CI were for categorical data.Results Nine studies (11 articles) involving 373 infants were included.Compared with ECC,DCC improved hematocrit (MD=4.19,95％CI:2.97-5.40,Z=6.74,P＜0.000 01),blood volume (MD=11.70,95％CI:6.02-17.38,Z=4.04,P＜0.0001) and mean arterial pressure of preterm infants with gestational age ＜32 weeks (MD=3.11,95 ％CI:1.30-4.92,Z=3.37,P=0.0008),decreased the usage of volume expansion for hypotension (OR=0.32,95％CI:0.11-0.98,Z=2.05,P=0.04) and the incidence of necrotizing enterocolitis (OR=0.48,95％CI:0.25-0.92,Z=2.22,P=0.03).Meanwhile,DCC had no influence on the peak bilirubin concentration,the incidence of sepsis,patent ductus arteriosus,retinopathy and intracranial hemorrhage,also no influence on neonatal mortality on dcscharge,mental developmental index and psychomotor developmental index at seven-month old.Conclusions DCC might be a safe procedure to improve prognosis of preterm infants less than 32 weeks' gestational age.However,due to small sample size and lack of data on follow up,it is necessary to launch clinical trials with higher quality and larger scale to further evaluate the effect and safety of DCC.
ABSTRACT
Objective To investigate the effects of anxiety and anti - anxiety therapy on vascular endothelium function and platelet activation in patients with acute coronary syndrome (ACS).Methods One hundred and thirty -nine ACS patients were enrolled in this prospective and controlled clinical study from January 2009 through December 2010.Patients with severe heart failure,liver and renal dysfunction,infection,allergy to benzodiazepines and taking antipsychotic drugs in recent 2 weeks as well as patients unable to complete the questionnaire were excluded.All these patients were divided into the anxiety group ( n =68 ) and the non - anxiety group ( n =71 ) according to Hamilton Anxiety Scale (HAMA).The plasma levels of NO,ET,CD62p,CD63 and flow- mediated diastolic functions (FMD) of humeral arteries were measured.The patients in anxiety group were randomly assigned to group A ( n =34 ) and group B ( n =34).Lorazepam in a dose of 0.5 mg twice a day and Vitamin B6 in dose of 10 mg twice a day as placebo were prescribed for patients of Group A and B respectively.After 2 weeks,all above variables of group A and group B were measured once again as well as the score of Hamilton Anxiety Scale.The chi - square test was used for constituent ratios,while t - test was applied to analysis of differences in above variables between two groups.Results The plasma level of NO and FMD of humeral artery in the anxiety group were significantly lower than those in the non -anxiety group (t =2.090 and 2.558,P =0.038 and 0.012,respectively),and the plasma levels of ET,CD62p and CD63 in the anxiety group were significantly higher than those in the non - anxiety group ( t =2.082,2.042 and 2.145,P =0.039,0.043 and 0.034,respectively).There were no statistical differences in all above variables as well as HAMA score between group A and group B before anti - anxiety treatment.Two weeks after treatment,the level of NO and FMD of humeral artery in group A were significantly higher than those in group B ( t =2.821 and 2.246,P =0,006 and 0.028,respectively) and the levels of ET,CD62p,CD63 and HAMA score in group A were significantly lower than those in group B ( t =2.107,3.242,2.079 and 7.779,P =0.039,0.002,0.041 and ＜0.01,respectively).Conclusions Anxiety mood markedly aggravates the disorder of vascular endothelial function and platelet activation,and both of them can be improved by anti - anxiety therapy.Consequently,the intervention in anxiety mood may improve the outcomes of ACS patients.
ABSTRACT
Objective To evaluate the predictive accuracy of several risk-assessment strategies to predict the risk of significant neonatal hyperbilirubinemia, and to establish the best prediction model.Methods The transcutancous bilirubin (TcB) levels of 4907 term and near-team infants were measured.Trace blood bilirubin levels of the infants whose TcB levels ≥250 μmol/L were detected. Clinical data of newborns and their mothers were collected and were analyzed with Logistic regression model to investigate its correlation with signifrcant hyperbilirubinemia. Clinical high risk factors of significant neonatal hyperbilirubinemia were determined. Accuracy of three prediction methods for significant hyperbilirubinemia was compared by receiver operating characteristic (ROC) curve. The three methods included: whether predischarge bilirubin level (within 72 hours after birth) expressed in risk zone on an hour-specific bilirubin nomogram; clinical risk factors other than predischarge bilirubin level; and combination of the predischarge bilirubin risk zone and other clinical risk factors. Results Two hundred and eighty-six newborns (5.8%) were found with significant hyperbilirubinemia. The risk factors of significant neonatal hyperbilirubinemia were divided into three groups according to OR: (1) Major risk factors:predischarge (within 72 hours after birth) bilirubin level in the high risk-zone (OR=96. 39, 95% CI:53.32-174.27, P = 0. 000), large cephalohematoma (OR = 36.45, 95% CI: 10. 02-132.56,P=0. 0076), gestational age 35-36+6 weeks (OR= 30. 72, 95% CI 14.47-65.23, P=0. 0001) and exclusive breast feeding and weight loss was ＞9% of birth-weight (OR=22.44, 95% CI: 4.42-114. 03, P=0. 0016). (2) Minor risk factors: gestational age 37-37+6 weeks (OR=3.26, 95% CI:1.92-5. 55, P=0. 0232), predischarge bilirubin level in P76-P95(OR=13. 64, 95% CI: 8. 10-22.97,P=0. 0001) and bruising (OR = 2.32, 95% CI: 1.14-4.71, P = 0. 0497). (3)Protective factors (those factors associated with decreased risk of hyperbilirubinemia): predischarge bilirubin level in low-risk zone (≤P40) (OR=0. 00), gestational age ≥40 weeks (OR=0.21, 95% CI: 0.09-0.44,P=0. 0402) and mixed breeding (OR=0. 75, 95% CI: 0. 58-0.95, P=0.0059). The area under the ROC curve of predischarge bilirubin level was 0. 8687 and 0. 7375 for clinical risk factors other than predischarge bilirubin level. The area under the ROC curve of a combination of the predischarge bilirubin risk zone and additional clinical risk factors was 0. 9367. Conclusions The risk of significant neonatal hyperbilirubinemia could be simply and accurately predicted by infant's predischarge bilirubin level and the combination of predischarge bilirubin level, and clinical risk factors might improve the accuracy of prediction significantly.
ABSTRACT
Objective To observe the effects of rosuvastatin on the homocysteine (Hcy)-induced expression of matrix metalloproteinase 2 (MMP 2) and cell migration in rat vascular smooth muscle cells (VSMCs), and to explore the possible mechanism of Hcy-induced atherosclerosis and the role of statins in reversing atherosclerosis. Methods In one cell culture plate, the cultured rat VSMCs were incubated with different concentrations of Hcy (0, 50, 100, 500, 1000 μmol/L and 5000 μmol/L) in vitro for 24 h, 48 h and 72 h. And in another cell culture plate, the different concentrations of rosuvastatin (10-9, 10-8, 10-7, 10-6, 10-5 mol/L and 0 mol/L) were added to the cultured rat VSMCs (while the concentration of Hcy was 1000 μmol/L). The MMP 2 expression and enzyme activity were determined by gelatin zymography and Western blotting. The effects of Hcy and rosuvastatin on cell migration and invasiveness of VSMCs were observed. Results Hcy (50-5000 μmol/L) increased the protein expression, and Hcy (50-1000 μmol/L) increased enzyme activity of MMP 2 significantly. But Hcy (5000 μmol/L) inhibited activity of MMP 2 (F=9.31, 6.44 and 5.97, all P＜0.05). Rosuvastatin (10-9-10-5 mol/L) inhibited Hcy-induced expression and enzyme activity increasing of MMP 2. The counts of cell migration of VSMCs were 18.32±2.17, 32.68±4.34, 44.75±4.08, 61.39±5.21, 79.74±5.54 and 90.78±5.83, while the concentration of Hcy was 0, 50, 100, 500, 1000 μmol/L and 5000 μmol/L respectively (F=5.31, P＜0.05). The counts of cell migration of VSMCs were 79.74±5.54, 62.53±6.41, 48.37±5.66, 31.41±4.79, 19.27±3.62 and 11.17±2.33, while the concentration of rosuvastatin was 10-9, 10-8, 10-7, 10-6 and 10-5 mol/L respectively (F=4.99, P＜0.05). Rosuvastatin could decrease the stimulation of Hcy-induced migration of VSMCs. Conclusions Hcy can influence the MMP 2 protein expression/activity in VSMCs, and rosuvastatin can inhibit augmentation of Hcy-induced MMP 2 expression/activity and migration of VSMCs. It may be one of the multiple-effects of rosuvastatin reducing atherosclerosis.
ABSTRACT
Objective To explore the expression of 11-β hydroxysteroid dehydrogenase 2 (11-β HSD2) gene in placenta of pregnancy induced hypertension (PIH) complicated by intrauterine growth retardation (IUGR) and the relationship between different expression of 11-β HSD2 in placenta and newborn's birth weight or placental weight. Methods Thirteen cases of term pregnancy mothers with PIH complicated by IUGR were served as PIH complicated by IUGR group, 22 cases of term pregnancy mothers complicated by PHI with appropriate for gestational age (AGA) infant as PIH with AGA group and 36 cases of normal controls as control group. The mRNA expression level of 11-β HSD2 gene in placenta was evaluated by RT-PCR. The level of cord serum cortisol was detected by the method of chemiluminescence. Results The 11-β HSD2 gene mRNA was expressed in placenta. The mRNA expression level of 11-β HSD2 gene in PIH complicated by IUGR group's placenta was significantly lower (0.26±0.09) than that in PIH with AGA group (0.64±0.19) and control group (0.66±0.20). The level of cord serum cortisol in PIH complicated by IUGR group was significantly higher [(71.60±20.20)μg/L] than that in PIH with AGA group [(51.00±13.80)μg/L] and control group [(49.10±14.40)μg/L]. The newborn's birth weight and placental weight in PIH complicated by IUGR group was significantly lower than those in PIH with AGA group and control group. The mRNA expression level of 11-β HSD2 gene in placenta was positively correlated with the birth weight of their newborns and placental weight. Conclusion The lower mRNA expression level of 11-β HSD2 gene in placenta may contribute to the higher cortisol level in fetal of PIH complicated by IUGR and has a negative role on the fetal development.
ABSTRACT
Objectives:To observe the role of combined use of early micro feeding and intravenous nutrition in low birth weight(LBW) infants. Methods:Fifty four cases of LBW infants were randomly divided into two groups.Early micro feeding and intravenous nutrition were given in one group(EF & IN group) and another group(Control group) was given only with intravenous nutrition.The times of intravenous nutritional support requirement and hospital stay,the increase in body weight and the changes in serum bilirubin,lipids and creatinine were compared between the two groups. Results:The times of intravenous nutritional support and hospital stay were shortened and the body weight was increased in EF & IN group. The levels of serum bilirubin and creatinine and the serial concentrations of lipids on the day 7 and 14 after birth were significantly lower than those in control group. Conclusions:The combination of early,micro feeding and intravenous nutrition is superior to the only use of intravenous nutrition in shortrenning the critical course,increasing the body weight,beginning the oral intake and decreasing the possible injuries from total parenteral nutrition.