Research progress of respiratory microecology and bronchopulmonary dysplasia / 中华实用儿科临床杂志

Bronchopulmonary dysplasia (BPD) is a common respiratory disease in preterm infants.Infection, inflammation and oxidative stress are the main pathogenic mechanisms of BPD.Recent studies have shown that the colonization of pulmonary microorganisms begins from the perinatal period and dynamically changed by multiple factors.Respiratory microecology dysbiosis may trigger oxidative stress, inhibit the expression of miR-876-3p, change pulmonary metabolism and weaken local barrier function, thereby leading to the occurrence and progress of BPD.At the same time, abnormal pulmonary development and lung injury also exert impact on respiratory microecology, and the impact even lasts till adulthood.Probiotics have anti-inflammatory, anti-infection and antioxidant effects.Supplementation of probiotics may promote lung development and alleviate lung injury conditions by regulating respiratory microecology.In this article, the establishment and dynamic changes of neonatal respiratory microecology were elaborated, and the role of respiratory microecology in the pathogenesis, prevention and treatment of BPD was explored.

Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia: a multicenter retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.@*METHODS@#This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years.@*RESULTS@#A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group.@*CONCLUSIONS@#In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.

Interpretation on Parenteral Provision of Micronutrients to Pediatric Patients: an International Expert Consensus Paper / 中华实用儿科临床杂志

Micronutrients, as coenzymes and cofactors for many metabolic processes, play an important role in parenteral nutrition, but the guidelines and expert consensus published cannot fully solve the problem with clinical application of micronutrients.Parenteral Provision of Micronutrients to Pediatric Patients: an International Expert Consensus Paper, released in September 2020 in the Journal of Parenteral and Enteral Nutrition, presented recommendations about common clinical questions for the assessment of micronutrients deficiency in children and the parenteral provision of micronutrients.The main content of International Expert Consensus Paper was interpreted in this article.

Research hotspots in pediatric teaching model in China over the past decade: a visualized analysis based on key words in literature / 中华医学教育探索杂志

Objective@#To summarize the research hotspots and knowledge structure of pediatric teaching model by introducing the co-word clustering analysis into the research on the current status of pediatric teaching model and conducting a visualized analysis of related articles in the past decade, and to provide a reference for further development of pediatric teaching model.@*Methods@#In July 2017, CNKI and Wanfang Data were searched for related articles published from January 2006 to June 2017, with "pediatrics" and "teaching model" as the key words. The articles which met the research criteria were screened out manually, and Word and Bicomb 2.0 were used to identify high-frequency key words. SPSS 20.0 was used to plot the diagram of the cluster analysis, and Ucinet 6.0 and Newdraw were used to generate the co-occurrence network map to show the relationship between high-frequency key words.@*Results@#A total of 367 articles were included and 31 high-frequency key words were extracted, among which the most frequently used key word was "PBL teaching method". Studies in this field were roughly classified into four types, i.e., teaching method in pediatric practice/and clerkship, contents of cultivation and assessments in pediatric teaching, teaching methods for pediatric nursing, and objects of the reform of teaching methods. The key words of "PBL teaching method", "multimedia teaching", "case-based teaching", and "nursing" were located at the center of the co-occurrence network map.@*Conclusion@#Exploration and practice of various teaching methods have been the main research topics in pediatric teaching model in China over the past decade. PBL is a research hotspot in this field and is often combined with multimedia, case teaching, or other methods in pediatric teaching. In addition, the application of evidence-based medicine has attracted more and more attention.

Research hotspots in pediatric teaching model in China over the past decade: a visualized analysis based on key words in literature / 中华医学教育探索杂志

Objective To summarize the research hotspots and knowledge structure of pediatric teaching model by introducing the co-word clustering analysis into the research on the current status of pediatric teaching model and conducting a visualized analysis of related articles in the past decade, and to provide a reference for further development of pediatric teaching model. Methods In July 2017, CNKI and Wanfang Data were searched for related articles published from January 2006 to June 2017 , with"pediatrics" and "teaching model" as the key words. The articles which met the research criteria were screened out manually, and Word and Bicomb 2.0 were used to identify high-frequency key words. SPSS 20.0 was used to plot the diagram of the cluster analysis, and Ucinet 6.0 and Newdraw were used to generate the co-occurrence network map to show the relationship between high-frequency key words. Results A total of 367 articles were included and 31 high-frequency key words were extracted , among which the most frequently used key word was"PBL teaching method". Studies in this field were roughly classified into four types, i.e., teaching method in pediatric practice/and clerkship, contents of cultivation and assessments in pediatric teaching, teaching methods for pediatric nursing, and objects of the reform of teaching methods. The key words of "PBL teaching method", "multimedia teaching", "case-based teaching", and "nursing"were located at the center of the co-occurrence network map. Conclusion Exploration and practice of various teaching methods have been the main research topics in pediatric teaching model in China over the past decade. PBL is a research hotspot in this field and is often combined with multimedia, case teaching , or other methods in pediatric teaching . In addition , the application of evidence-based medicine has attracted more and more attention.

A clinical study on the effects of exchange transfusion and intensive phototherapy on neurodevelopment in neonates with severe hyperbilirubinemia / 中国新生儿科杂志

Objective To study the effects of exchange transfusion(ET) and intensive phototherapy (IPT) on neurodevelopment in neonates with severe hyperbilirubinemia reaching ET criteria.Method From January 2015 to March 2016,neonates with severe hyperbilirubinemia reaching ET criteria with gestational age ≥35 weeks,and hospitalized in the Department of Neonatology of our hospital were enrolled in the study.The parents were informed of the risks of acute bilirubin encephalopathy (ABE) and both the advantages and disadvantages of IPT and ET.Based on the different choices of their parents,the neonates were assigned into the ET group and the IPT group.General conditions,treatment effects,the incidences of ABE and the prognosis were recorded and analyzed.Result A total of 335 patients were included in this study,147 in the ET group and 188 in the IPT group.Before intervention,the peak of total serum bilirubin (TSB) in ET group (475.8± 100.6 μmol/L) was higher than IPT group (398.3±39.8 μmol/L) (the difference of TSB between two groups was 77.4 μmol/L,P＜0.001),and the incidences of high risk factors such as blood incompatibilities,sepsis,cranial hematoma and intracranial hemorrhage in ET group were higher than IPT group (P＜0.05).Compared with at admission,the incidence of ABE in the ET group increased from 32.0％ to 34.0％ at discharge,mainly due to moderate and severe ABE (the ratio of moderate ABE increased from 2.7％ to 10.2％,and severe ABE increase from 2.7％ to 4.8％).Statistically significant differences existed in the proportion of ABE with different severity at admission and discharge in ET group (P＜0.05),while that in IPT group wasn't statistically significant.241 patients were followed up (follow-up rate 71.9％),with the age ranging from 20 to 36 months.6 cases (5.7％,6/106) in the ET group showed hearing disorder while none (0％,0/135) in the IPT group (P＜0.05).The incidences of neuromotor dyskinesia,language development disorder and spasm in ET group were higher than IPT group(7.5％ vs.3.7％,3.8％ vs.1.5％,4.7％ vs.4.4％,respectively),but the differences weren't statistically significant(P＞ 0.05).No deaths were observed in both groups.Conclusion In neonates with severe hyperbilirubinemia whose TSB exceeding the upper limit of current ET criteria (and within upper limit+5 mg/dl),if the neonates have no risk factors nor clinical symptoms of moderate or severe ABE,only IPT and without ET does not increase the incidence of unfavourable prognosis of central nervous system.

Research progress of enteral nutrition in very low birth weight infants / 中华实用儿科临床杂志

The nervous system of very low birth weight infants is particularly sensitive to malnutrition.The growth and neural development of very low birth weight infants will be limited by various nutritional deficiencies.Early enteral nutrition is beneficial for the growth and neural development of very low birth weight infants.However,there is still a controversy about the timing of starting enteral nutrition,the amount of milk to be fed,the rate of adding milk and whether strengthening breast milk or adding probiotics.This article reviews the problems and controversy of enteral nutrition in very low birth weight infants.

Influence factors for bronchopulmonary dysplasia in different gestational age premature infants / 中华实用儿科临床杂志

Objective To explore the influence factors for bronchopulmonary dysplasia(BPD) in different gestational age preterm infants.Methods The medical records of 118 premature infants who were diagnosed as BPD at West China Second Hospital,Sichuan University from January 1,2011 to December 31,2015 were retrospectively analyzed.According to the gestational age,the premature infants were divided into extremely-early-premature infants group (＜ 28 weeks),very-early-premature infants group (28-31 weeks) and late-premature infants group (32-36 weeks).The differences in pregnancy complications,the use of glucocorticoids before delivery,gender,mode of production,medication for preterm infants with different gestational age preterm infants were analyzed.Results One hundred and eighteen preterm infants included 18 extremely-early-premature infants,82 very-early-premature infants,and 18 late-preterm infants;71 baby boys and 47 baby girls,with birth weight ≤1 000 g in 27 cases,1 000-1 500 g in 70 cases,1 500-2 000 g in 15 cases,and ＞2 000 g in 6 cases.There was a statistically significant difference as for the full use of continuous positive airway pressure between the extremely-early-premature infants group (9 cases) and the late-preterm infants group(2 cases) (x2 =6.415,P =0.011).The late-preterm infants group whose mothers experienced preeclampsia were more seriously affect than extremely-early premature infants group (x2 =4.018,P =0.045) and very-early-premature infants group (x2 =4.878,P =0.027),and there was no statistically significant difference between extremely-early-premature infants group and very-early-premature infants group (x2 =0.279,P =0.597).A significantly increased total oxygen duration was observed in extremely-early-premature infants group [(56.56 ± 29.58) d] compared with very-early-premature infants group[(43.15 ± 14.86) d] and late-preterm-infants group [(37.75 ± 16.87) d] (F =8.185,P =0.000) with statistically significant difference.A significantly increased hospitalization time was observed in extremely-early-premature infants group [(56.56 ± 29.58) d] com-pared with very early premature infants group [(46.23 ± 14.04) d] and late-preterm-infants group [(39.06 ± 29.81) d] (F =5.606,P =0.004).Conclusions The number of BPD in extremely-early-premature infants and very-early-premature infants increases compared with that in the late-preterm infants.Gestational age is the high risk factor for the occurrence of BPD,the gestational age should be delayed as late as possible.Prevention of extremely-early-premature birth and very-early-premature birth,and avoidance of intrauterine hypoxia and rational use of oxygen are the important measures for prevention of BPD occurred in premature infants and reducing hospitalization time.

Autophagy in hippocampal nerve cells from rats with sepsis-associated encephalopathy / 中南大学学报(医学版)

OBJECTIVE@#To show evidence of the autophagy in hippocampal nerve cells from rats with sepsis-associated encephalopathy (SAE) in vivo and to investigate the expression of microtubule-associated protein 1 light chain 3 (LC3). 
@*METHODS@#A rat model of sepsis was established by the cecal ligation and puncture (CLP). A total of 60 male Wistar rats (30 days old) were randomly divided into a sham group (n=10) and a CLP group (n=50). At 12 hours after CLP, the electroencephalogram (EEG) and somatosensory evoked potential (SEP) changes in rats were monitored and the neurobehavioral score was measured. According to the occurrence of SAE, the CLP group was further divided into an SAE(+) group and an SAE(-) group. Histopathological changes in hippocampus were observed by hematoxylin-eosin staining. An electron microscope was used to observe autophagosome formation and lysosome activation in the hippocampal nerve cells. Expressions of LC3-I and LC3-II protein were measured by Western blot. 
@*RESULTS@#Five of 50 rats in CLP group died in 12 hours after CLP. According to the low neurobehavioral score and abnormal EEG and SEP, 16 rats were diagnosed as SAE. The incidence of SAE was 35.56% (16/45). Compared with the sham group or the SAE(-) group, the frequency of α wave in SAE(+) group was significantly decreased at 12 hours after CLP, the δ wave increased, the P1 amplitude decreased, and the latency of SEP waves (P1 and N1) was prolonged (P<0.05). The morphology of hippocampal nerve cells was obvious in a status of edema. Pyramidal cells decreased significantly, even dissolved, and cell arrangement was in disorder in the SAE(+) group. But these cells were normal in the sham group and the SAE(-) group. The structure of hippocampal nerve cells was disordered, and the autophagy, granular matrix and square or rectangular crystals were found in the SAE(+) group. However, there was no autophagy both in the sham group and the SAE(-) group. LC3-II/LC3-I ratio in the hippocampal nerve cells was increased significantly at 12 hours after CLP in the SAE(+) group when compared with that in the sham or the SAE(-) group (P<0.05). 
@*CONCLUSION@#There is autophagy in hippocampal nerve cells from rats with SAE and the LC3-II/LC3-I ratio is increased significantly.

Role of brain -derived neurotrophic factor in pathological mechanism of autism spectrum disorder / 中华实用儿科临床杂志

The brain -derived neurotrophic factor (BDNF)plays an important role in the development and function of the nervous system.BDNF controls the neuronal survival,differentiation,growth of dendrites and axons,for-mation of synapse,neuronal plasticity and the basic process of learning and memory through a variety of ways,the dys-regulation of which is probably the important molecular mechanism responsible for the onset of autism spectrum disor-der.The research advance on preclinical research and clinical research between BDNF and autism spectrum disorder is reviewed in this paper.

Long non-coding RNA expression in neonatal rat brain tissue after hypoxic-ischemic injury / 中华实用儿科临床杂志

Objective To investigate the expression of long non - coding RNA(lncRNA)in neonatal rats with hypoxic - ischemic brain damage(HIBD). Methods SD rats of 10 postnatal days were divided into the sham -operated control and the hypoxic - ischemic(HI)group. At 24 h after HI,the animals were sacrificed. HE staining was used to assess histopathological damage. Microarray was used to detect the expression of lncRNA and mRNA in hypoxic -ischemic and sham control brain. Real - time PCR was used to verify the microarray result. The differentially expressed mRNA was analyzed by gene ontology(GO),pathway and coding - noncoding RNA co - expression(CNC)network analysis. Results HE staining showed that cells in HI brains became swollen and disordered with ambiguous cell struc-ture. Microarray data demonstrated that 322 lncRNAs and 375 mRNAs were significantly altered in the neonatal brains following hypoxic - ischemic injury compared with sham control(P ﹤ 0. 05). The real - time PCR results agreed with those of the microarray. GO analysis showed that the most enriched biological process associated with the upregulated mRNA had response to wounding,whereas the biological process mostly enriched among the downregulated mRNA was so-matic stem cell division. Pathway analysis indicated that upregulated mRNA was primarily corresponded with cytokine -cytokine receptor interaction pathway and that downregulated mRNA mainly correlated to axon guidance pathway. CNC network analysis demonstrated that 177 lncRNAs were correlated to the expression of mRNA involved in inflammation and cell death(P ﹤0. 05). Conclusions HI injury significantly influences cerebral lncRNA and mRNA expression profiles in the neonatal rat brains. Deregulated lncRNAs might contribute to the pathogenesis of HIBD via interacting with mRNA.

Transcatheter occlusion of patent ductus arteriosus in a preterm infant and review of literatures / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of haemodynamically significant patent ductus arteriosus (hsPDA), and the indications of percutaneous transcatheter PDA occlusion.</p><p><b>METHOD</b>The data of a preterm infant admitted to West China Second Hospital in December. 2013, who finally underwent percutaneous transcatheter PDA occlusion were analyzed With the key words of"preterm"patent ductus arteriosus"transcatheter", Pubmed were searched and potentially relevant reports were retrieved and assessed by manual sorting from 2005 to 2015. Relevant reports in literature were reviewed.</p><p><b>RESULT</b>A preterm infnat at gestational age of 35 weeks with birth weight of 1 900 g was admitted to our department. Oral ibuprofen for closure of the patent ductus arteriosus failed, and the patient exhibited the features of"ventilator dependent"PDA of premature infants. On the 30th postnatal day, with the body weight of 1 950 g, under basal anesthesia, the infant underwent percutaneous transcatheter PDA occlusion, and the procedure successfully occluded the ductus with Amplatzer duct occluder (ADO). The ventilator was weaned 19 hours post procedure, and the child was discharged 7 days post operation with good recovery, and her growth and development was good. Follow-up for 13 months indicated that the intelligence and physical development evaluated by Bayley scales of infant development test were at the same level of normal age-matched infants. Fifty-two preterm infants treated with percutaneous transcatheter PDA occlusion in 8 reports were enrolled. The preterm infants were born at 23-35 gestational weeks, with PDA diameter of 1-4 mm. The occlusive device included coil, ADO, ADO Ⅱ, ADO Ⅱ AS, AVP Ⅱ and AVP Ⅳ respectively, with body weight of 870-2 610 g on operational days and age of 11-90 postnatal days. All those infants either failed or had contraindications to drug therapy, and exhibited as hsPDA cases. Percutaneous transcatheter PDA occlusions were performed successfully in all 52 cases, and there were no serious procedure-related complications.</p><p><b>CONCLUSION</b>Percutaneous transcatheter PDA occlusion in preterm infants is feasible and showed positive short-term and long-term effects, which provides an important alternative way for patients with the problem. The indications for transcatheter PDA occlusion include premature infants with hsPDA in whom drug therapy failed or is contraindicated.</p>

Visualized study of current status of the research in neonatal non-invasive ventilation / 临床儿科杂志

ObjectivesTo present the current condition of non-invasive ventilation in newborns in the last ifve years in China, to describe the probable research trends of this ifeld, and to provide the possible research directions in future.Methods Using co-word analysis, the keywords “neonate” and “non-invasive ventilation” were searched in the CNKI database. The search results included 457 articles. Then the relation matrix was built by Excel 2010. Finally the visualized network was drawn by Ucinet 6.3.ResultsNasal continuous positive airway pressure (nCPAP) is primarily for the treatment of neonatal respiratory distress syndrome (NRDS) in China. Meanwhile, nasal intermittent positive pressure ventilation (nIPPV) and bilevel positive airway pressure (BiPAP) are gradually applied in clinic. The application scope of non-invasive ventilation is expanding. Besides the neonatologists, nurses are also paying close attention to non-invasive ventilation.ConclusionsThe visualized network, successfully built by Netdraw, relfects the hot topics and current condition in this ifeld.

Intrauterine infection and neonatal brain damage / 临床儿科杂志

Intrauterine infection is an important risk factor for neonatal brain damage and neurological dysfunction. Viruses, bacteria, and protozoa can cause intrauterine infection which results in neonatal brain damage. The inlfammatory response is an important pathogenic factor for neonatal brain damage caused by intrauterine infection. Intrauterine infection in different periods of pregnancy might cause different types of brain damage in neonates. Clinicians should pay attention to the prevention of intrauterine infection during pregnancy. It is necessary to further strengthen the clinical and basic research to explore effective interventions for neonatal brain damage caused by intrauterine infection.

Clinical evidence for immunologic treatment in newborn infants with sepsis / 中华实用儿科临床杂志

Objective Neonatal sepsis (NS) is one of the main causes of neonatal death.Immune therapy is an important way in the comprehensive treatment of NS.This study investigated several databases in order to find the clinical evidence for the immunological treatment of neonatal sepsis (NS),and to explore its clinical application value.Methods Systematic reviews and randomized (or quasi-randomized) controlled trials (RCT) for immunological treatment of NS in newborn infants were searched from the databases of MEDLINE,EMBASE and Cochrane Library.The relevant literatures were statistically analyzed.Results Six systematic reviews (including 37 RCTs) were found to be involved in the therapy,and the drugs included intravenous immunoglobulin (containing high level of IgM),antistaphylococcal immunoglobulins,neutrophile granulocyte,granulocyte colony-stimulating factor,granulocyte-macrophage colony-stimulating factor,pentoxifylline and glutamine.Pentoxifylline could decrease the mortality (Z =2.71,P =0.006 8),shorten the hospitalization (Z =2.01,P =0.044),and reduce the incidence rate of necrotizing enterocolitis (NEC) (Z =1.67,P =0.095) of the NS infants.No therapeutic effect was found for other drugs in the treatment of NS.Conclusions Current clinical evidence for the immunological treatment of NS indicates that only Pentoxifylline could decrease the mortality,reduce the incidence rate of NEC and shorten the hospitalization of infants with NS.However,current evidence is only a small scale sampling and lacks multicenter studies.Researchers are encouraged to undertake large scale and well-designed multicenter trials to confirm the effectiveness of the immunological treatment of NS.

Neurodevelopmental outcome at 18 months of late preterm infants / 中华实用儿科临床杂志

Objective To study the neurodevelopmental outcome prospectively at 18 months of the late preterm infants.Methods Data from 7 584 live born neonates were collected between January and December.2009 in 3 hospitals located in the north of Chengdu City,Sichuan Province were collected,89 late preterm infants were brought into study ; 170 healthy full-term infants were chosen as the controls randomly.Neurodevelopment outcome was assessed by using neonatal behavioral neurological assessment(NBNA) at 40 weeks corrected gestational age,and Bayley scales of infant development was performed to obtain the physical development index (PDI) and mental development index (MDI) at 3,6,9,12 and 18 months corrected age.Neurodevelopmental outcome of late preterm infants was studied compared with that of the term infants.Results Sixty-three neonates born at the late preterm phase and 115 neonates born at the term phase were successfully followed up.The NBNA scores of the late preterm infants at 40 weeks corrected gestationa] age were significantly lower than those of the term infants.The proportion of the late preterm infants whose scores ≥37 was significantly lower than that of the term infants(82.5％ vs 94.8％),the proportion of late preterm infants whose scores ＜35 was significantly higher than that of the term infants(4.8％ vs 0),the proportion of the late preterm infants whose scores in 35-36 was significantly higher than that of the term infants (12.7％ vs 5.2％,Z =-2.707,P ＜ 0.05) ;At 3,6,9 and 12 months corrected age,the late preterm infants showed a significant lower PDI scores(t =-4.266,-4.594,-5.663,-2.584) and MDI scores (t =-7.121,-7.829,-7.038,-6.002) than those of the term infants(all P ＜0.05).Compared with the term infants,the late preterm infants still had lower MDI scores than the term infants at 18 months corrected age(t =-4.115,P ＜0.05),but no difference was observed in PDI scores between late preterm and the term infants (t =-0.957,P ＞ 0.05).Conclusions Neurodevelopment outcome of the late preterm infants is delayed in the first year compared with term infants.At 18 months corrected age the mental development is still delayed compared with the term infants.Measures should be taken properly to improve the neurodevelopment of the late preterm infants in the early childhood.

Neurodevelopment in late preterm infant / 中华实用儿科临床杂志

Compared with term infants,late preterm infants experience poorer neurodevelopment outcomes such as cerebral palsy,developmental delay,mental retardation,school performance and behavioural problems because of their immature brain,impact of diseases,neonatal care and later education.Case history,early neurodevelopment evaluation,electrophysiology evaluation and neuroimaging evaluation are needed to early identify neurodevelopment disability.Similarly,appropriate intervention such as daily function training,rehabilitation training,psychotherapy,special school education and a long-term evaluation,monitoring and follow-up of late preterm infants are needed to improve human health status.

The expression and role of integrin-linked kinase in neonatal rats after hypoxia-ischemia brain damage / 临床儿科杂志

Objective To investigate the possible function of integrin-linked kinase (ILK)/protein kinase B (PKB/Akt) signaling in repair of neonatal rat hypoxia-ischemia brain damage (HIBD). Methods Postnatal day 10 SD rats were randomly divided into hypoxia ischemia (HI) group and sham control group. Rat brains were collected at 0 h, 4 h, 6 h, 12 h, 24 h, 48 h and 72 h after hypoxia ischemia damage. Immunolfuorescence staining was used to observe the distribution and expression of ILK. Western blot was used to detect the expression of ILK, Akt, phosphorylated Akt (p-Akt) and vascular endothelial growth factor (VEGF). Lentiviral vectors expressing ILK shRNA were constructed to inhibit the expression of ILK in neonatal rats. After intracerebroventricular injections of LV-ILK shRNA lentivirus and LV-control respectively, HIBD model was established. Rat brains were collected at 4 h and 24 h after HIBD. Western blot was used to detect the expression of ILK, p-Akt, and VEGF. TdT-mediated dUTP-biotin nick end labeling (TUNEL) staining was used to detect cell apoptosis. Results Immunolfuorescence staining showed that ILK was widely distributed in cortex and hippocampus both in HI group and sham control group. ILK located at cell membrane and cytoplasm. Western blot results demonstrated that ILK protein increased after HI, with a peak at 24 h, and maintained higher level than those in sham control group. The p-Akt protein signiifcantly increased at 4 h after HI, and signiifcantly decreased in the following 24 h, and then increased again, with a peak at 48 h, but the level of p-Akt protein was higher than that of sham control group. The VEGF protein increased at 4 h after HI, with a peak at 12 h, higher than that of sham control group. The expression of Akt protein showed no signiifcant difference between HI group and sham control group. Lentiviral vectors containing RNAi targeting ILK was applied successfully in vivo. At 4 h and 24 h after HIBD model, the expression of ILK, p-Akt, and VEGF proteins in right side brain received LV-ILK shRNA signiifcantly decreased compared with those of right side brain received LV-control at the same time point. And cell apoptosis signiifcantly increased in LV-ILK shRNA group. Conclusions The expression of ILK, p-Akt, VEGF proteins increased after HI. By inhibiting the expression of ILK, the expression of p-Akt and VEGF proteins can be reduced, and cell apoptosis could increase in newborn rats after HIBD. The results suggest that ILK may induce the expression of VEGF through activating the PI3K/Akt signaling pathway, and promote cell survival and angiogenesis after HIBD.

Expression of apoptotic protease cysteinyl aspartate specific proteinase-3 in cortex of rats with sepsis / 中华实用儿科临床杂志

Objective To investigate the expression of apoptotic protease cysteinyl aspartate specific proteinase (caspase-3) in cortex neurons of rats with sepsis.Methods Models of rats with sepsis were established by the cecal ligation and puncture (CLP).Totally 70 cases of 30-day-old male Wistar rats were randomly divided into CLP group (n =50) and control group (n =20).In CLP group,CLP was performed in the rats.Neurobehavioral score was measured in 5 rats at 6,12,24 and 48 h after CLP surgery,respectively.Then,they were killed and their brains were removed.The immunohistochemical staining and Western blot were used to detect the apoptotic protein caspase-3 expression in cortex of rats.Control group did not undergo CLP,and the other treatment was the same as CLP group.Results Neurobehavioral scores at 12,24 and 48 h after CLP surgery were significantly lower than that in the control group(t =3.651,3.773,7.155,all P ＜ 0.05),and the scores were gradually decreased,overall situation of rats was getting worse along with the time.Caspase-3 protein expressed only in trace amounts in rat cerebral cortex in the control group by immunofluorescence analysis,however,its expression was significantly increased at 12 h after CLP surgery.Western blot test showed that caspase-3 protein expression in rat cerebral cortex at 6,12 and 24 h after CLP surgery was significantly higher than those in control group (all P ＜ 0.05).Its expression began to increase at 6 h after CLP surgery,and reached the peak at 12 h,then decreased at 48 h.Conclusion The neurobehavioral scores decreases and the expression of apeptosis protease caspase-3 increases in cortex of rats with sepsis brain injury.

Combining serial casting with botulinum toxin A in the treatment of spastic equinus in children with cerebral palsy / 中华物理医学与康复杂志

Objective To compare the effect of injection with botulinum toxin type A (BTX-A) before serial casting with BTX-A injection alone for the treatment of spastic equinus in children with cerebral palsy (CP).Methods Sixty patients were divided into an experimental group and a control group with 30 patients in each.Those io the experimental group received a BTX-A injection followed by serial casting,while the controls received BTX-A only.Before treatment and 1 month,3 months and 6 months after treatment,the dorsiflexion range of motion (ROM)of the ankle recorded while the knee in flexion and extension were measured,and gait was evaluated with an observational gait scale.Results Before treatment there was no significant inter-group difference in any of the 3 outcome measures.At 1 montb,3 months and 6 months after treatment,there were significant inter-group differences in all 3 measures,and also significant differences compared with before treatment in both groups.Conclusion Lower muscle tone,greater ankle mobility and better gait patterns can be promoted in CP children with spastic equinus using serial casting combined with BTX-A injection.The improvements may last longer than those after BTX-A injection alone.