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Objective:To study the characteristics and related factors of neonatal intestinal necrosis caused by midgut volvulus.Methods:We retrospectively analyzed the clinical data of neonates with midgut volvulus who were admitted to Guangzhou Women and Children's Medical Center, from January 2009 to December 2019 and confirmed by surgery. The cases with intestinal necrosis belong to the intestinal necrosis group, and those without intestinal necrosis, the non-intestinal necrosis group which was randomly sampled at a ratio of about 4∶1 to the number of cases in the intestinal necrosis group. The two groups were compared in terms of personal history, age of onset, initial symptoms, vital signs within 2 h after admission, time from symptom onset to operation, clinical outcome, laboratory indicators within 2 h after admission, etc. Multivariate Logistic regression analysis was used to screen the related factors of intestinal necrosis in midgut volvulus. The effective warning indexes are screened by receiver operating characteristic (ROC) curve.Results:(1) Among 231 cases of midgut volvulus, 21 cases (9.1%, 21/231) had intestinal necrosis at the time of operation, 87 cases were included in the non-intestinal necrosis group. (2) The levels of heart rate within 2 h after admission, mean arterial pressure, WBC, C reactive protein (CRP), blood glucose and potassium in intestinal necrosis group were significantly higher than those in non-intestinal necrosis group ( P<0.05). Admission days of age, hemoglobin, serum albumin, serum sodium, pH and BE levels were significantly lower than those in the group without intestinal necrosis ( P<0.05). (3) In the multivariate analysis, increased heart rate, mean arterial pressure, serum CRP, and decreased serum sodium, serum albumin, and pH levels were predictors related to intestinal necrosis in patients with midgut volvulus. (4) The area under the ROC curve (AUC) of CRP was 0.883, the cutoff value was 9.88 mg/L, the sensitivity was 76.2%, and the specificity was 94.3%. The ROC curve of serum albumin was 0.792, the cut-off value was 36.65 g/L, the sensitivity was 70.1%, and the specificity was 94.3%. Conclusions:Heart rate, mean arterial pressure, increased CRP, decreased serum sodium, serum albumin and pH are helpful to predict whether intestinal necrosis occurs in midgut volvulus, and CRP > 9.88 mg/L and serum albumin < 36.65 g/L are likely warning indicators.
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@#Objective To summarize the electrophysiological indexes and scales used for evaluation of post-stroke spasticity, for integration of clinical management of spasms. Methods Literatures on identification and evaluation of post-stroke spasticity from databases of Web of Science, PubMed, CNKI, and Wanfang Data up to May 15, 2021 were retrieved and the indicators related to post-stroke spasticity were extracted for a scoping review. Results The scales of modified Asworth Scale, Comprehensive Spasticity Scale and modified Tardieu Scale; the electrophysiological indexes of F wave, H reflex, motor evoked potentials, visual-startle reaction time and vestibular evoked myogenic potentials were used to identify and evaluate post-stroke spasticity. Conclusion More clinical researches are needed to explore earlier identification and evaluation of post-stroke spasticity more objectively and accurately.
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Objective To study the effect of multi-disciplinary team (MDT) management on the outcome in neonates with omphalocele.Method A retrospective non-randomized controlled clinical study was conducted.Neonates who were diagnosed as omphalocele and admitted to the surgical neonatal intensive care unit of the Guangzhou Women and Children Medical Center from December 2010 to December 2017 were collected.Because MDT was established in December 2014,infants were assigned into non-MDT group and MDT group according to their dates of admission.The characteristics and outcomes between non-MDT group and MDT group were compared using x2,t-test or rank-sum test.Multivariate analysis was performed by Logistic regression.Result A total of 91 neonates were included in the study,50 were in non-MDT group and 41 were in MDT group.The mortality in MDT group (2.4％,1/41) was lower than that in non-MDT group (18.0％,9/50),the difference was statistically significant (P ＜ 0.05).The median time of mechanical ventilation of giant omphalocele in non-MDT group (18.3 hours) was longer than that in MDT group (41.7 hours),the difference was also statistically significant (P ＜ 0.05).After adjusting for the associated confounding risk factors,the risk of death in non-MDT group was 54 times higher than that in MDTgroup (OR=54.19,95％CI2.64 ～1 113.49,P＜0.05).Conclusion There was significant association between the MDT management and the decreased risk of death of omphalocele.
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Objective To compare the prognosis of different surgical procedures and to find the relatively safe and effective treatment for severe jejunoileal atresia(sJA).Method From January 2007 to June 2018,children with sJA receiving different surgical procedures in our hospital were retrospectively reviewed.Their clinical data were analyzed,including the survival rate,complication rate,unplanned re-operation rate and postoperative nutritional status.Result A total of 130 patients were enrolled in this study.According to the different types of surgical procedures,the patients were assigned into primary anastomosis group (58 cases,44.6％),Mikulicz double barrel ileostomy group (17 cases,13.1％) and Bishop-Koop anastomosis group (55 cases,42.3％).The overall mortality rate was 6.2％ (8/130).No significant differences existed in mortality rates among the three groups (P＞0.05).The incidences of gastrointestinal complications in primary anastomosis group (70.6％,12/17) and Mikulicz group (70.6％,12/17) were both higher Bishop-Koop group (34.5％,19/55),the differences were statistically significant (P＜0.05).The unplanned re-operation rates were 34.5％ (20/58) in the primary anastomosis group and 17.6％ (3/17) in the Mikulicz group,both higher than the Bishop-Koop group (3.6％,2/55),the differences were also statistically significant (P＜0.05).Multivariate analysis showed that the risk of complications in the primary anastomosis group (OR=3.434,95％CI 1.392～8.471) and Mikulicz group (OR=5.933,95％CI 1.467～23.991) were higher than the Bishop-Koop group.The risk of unplanned re-operation in the primary anastomosis group was 12.422 times as the Bishop-Koop group (95％CI 2.535～60.877).No significant differences existed between the Mikulicz group and the Bishop-Koop group in the risk of unplanned re-operation (P＞0.05).The weight for age (Z-score) in the Bishop-Koop group (-1.4,95％CI-2.0～-0.8) at the stoma closure time was better than the Mikulicz group (-3.2,95％CI-4.4～-2.0),the difference was statistically significant (P＜0.01).Conclusion Bishop-Koop anastomosis has lower complication rate and lower unplanned re-operation rate in the treatment of sJA.The nutritional status of children who received Bishop-Koop anastomosis is better than Mikulicz double barrel ileostomy at the stoma closure time.Bishop-Koop anastomosis is relatively safe and effective for sJA patients.
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Objective To investigate the association between people who were under lack of care in childhood and the development of cognitive impairment in their middle-aged and elderly life spans.Methods Based on the baseline survey data of the third phase of "Guangzhou Biobank Cohort study" conducted from January 2007 to January 2008,9 223 residents aged ≥50 years with records on Mini Mental State Examination (MMSE) were included in a retrospective survey on received childhood carc of their early lives.Questions would include:feelings of care and support from their close relatives during childhood,the status of separation from their mothers for ≥ 1 year,and the current status of their parents.Linear regression,unconditional and multinomial logistic regression models were used to analyze the associations between the received childhood care and cognitive function (i.e.,MMSE scores and cognitive impairment) in middle and old age,of this population under study.Results After adjusting for age,gender,education,place of residence,marital status,physical activity,smoking,drinking,occupation,personal income,childhood socioeconomic position and depressive symptoms etc.,factors as feeling lack of concern and support from close relatives (LC),status of separation from the mother for ≥ 1 year (SM),and the current status of their parents etc.,were all negatively associated with the MMSE score when in middle and old age,with partial regression coefficient β (95％CI) as-0.44 (-0.65--0.23),-0.26 (-0.38--0.14) and-0.61 (-0.96--0.27),respectively.The presence ofLC,SM or PD were associated with the increased risks of cognitive impairment,and the adjusted odds ratio OR (95％CI) appeared as 1.43 (1.15-1.78),1.26 (1.08-1.47) and 1.64 (1.16-2.31)respectively in all the participants,but 1.27 (1.01-1.62),1.29 (1.09-1.55) and 1.75 (1.19-2.55) respectively,in those with education level of primary school or below.In those with secondary school education or above,only the presence of item A was associated with an increased risk of cognitive impairment (OR=2.26,95％CI:1.41-3.50).Conclusion We noticed that ‘lack of care'in childhood was associated with cognitive impairment during middle and old age,mainly in those population with lower education.
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Objective To study the nutritional status and risk factors in neonates receiving enterostomy.Method From January 2015 to July 2017,patients who had enterostomy during neonatal period and had the stoma closed in our hospital were retrospectively studied.Z score (weight-for-age) was used to evaluate their nutritional status.The patients were divided into two groups according to the nutritional status when the stoma closed:the malnutrition group and the normal nutrition group.The differences in gender,premature birth,low birth weight,primary disease,ostomy methods,length of proximal small intestine and high output diarrhea through stoma were compared between the two groups.Multivariate Logistic regression analysis was used to determine the risk factors of malnutrition at the closure of the stoma.Result A total of 75 infants with various primary diseases were included.Among them,23 patients were diagnosed with neonatal necrotizing enterocolitis,27 patients jejunoileal atresia,5 patients meconium ileus,15 patients meconium peritonitis and 5 patients Hirschsprung's disease.The median age of enterostomy was 3 (2,8) days,and the median hospital stay after enterostomy was 26 (20,40) days.The median age of stoma closure was 6.0 (5.0,8.5) months.The median Z score at discharge and stoma closure were -1.6 (-2.9,-0.9) and-1.5 (-2.6,-0.5) respectively.No statistically significant differences existed between the two groups (P ＞ 0.05).28 infants (37.3％) were malnutrition when the stoma was closed.The incidence of low birth weight and high output diarrhea through stoma in malnutrition group were significantly higher than the normal nutrition group (35.7％ vs.10.6％,32.1％ vs.10.6％,P ＜0.05).No significant differences in gender,premature birth rate,primary disease,ostomy method and length of proximal intestine between the two groups (P ＞ 0.05).Multivariate Logistic regression analysis indicated that low birth weight,high output diarrhea and jejunoileal atresia were risk factors for malnutrition.Conclusion Malnutrition is common in neonates after enterostomy,and the risk factors for malnutrition are low birth weight,high output diarrhea through stoma and the primary disease jejunoileal atresia.
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Objective To investigate the association between people who were under lack of care in childhood and the development of cognitive impairment in their middle-aged and elderly life spans.Methods Based on the baseline survey data of the third phase of "Guangzhou Biobank Cohort study" conducted from January 2007 to January 2008,9 223 residents aged ≥50 years with records on Mini Mental State Examination (MMSE) were included in a retrospective survey on received childhood carc of their early lives.Questions would include:feelings of care and support from their close relatives during childhood,the status of separation from their mothers for ≥ 1 year,and the current status of their parents.Linear regression,unconditional and multinomial logistic regression models were used to analyze the associations between the received childhood care and cognitive function (i.e.,MMSE scores and cognitive impairment) in middle and old age,of this population under study.Results After adjusting for age,gender,education,place of residence,marital status,physical activity,smoking,drinking,occupation,personal income,childhood socioeconomic position and depressive symptoms etc.,factors as feeling lack of concern and support from close relatives (LC),status of separation from the mother for ≥ 1 year (SM),and the current status of their parents etc.,were all negatively associated with the MMSE score when in middle and old age,with partial regression coefficient β (95％CI) as-0.44 (-0.65--0.23),-0.26 (-0.38--0.14) and-0.61 (-0.96--0.27),respectively.The presence ofLC,SM or PD were associated with the increased risks of cognitive impairment,and the adjusted odds ratio OR (95％CI) appeared as 1.43 (1.15-1.78),1.26 (1.08-1.47) and 1.64 (1.16-2.31)respectively in all the participants,but 1.27 (1.01-1.62),1.29 (1.09-1.55) and 1.75 (1.19-2.55) respectively,in those with education level of primary school or below.In those with secondary school education or above,only the presence of item A was associated with an increased risk of cognitive impairment (OR=2.26,95％CI:1.41-3.50).Conclusion We noticed that ‘lack of care'in childhood was associated with cognitive impairment during middle and old age,mainly in those population with lower education.
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Objective To study the immune system regulatory effects of CD8+CD28-regulatory T lymphocytes in an experimental bone marrow mesenchymal stem cell treatment of autoimmune encephalomyelitis.Methods A model of autoimmune encephalomyelitis (EAE) was established in twenty-eight C57BL/6 female mice,6 to 8 weeks old weighing 16 to 20 g using myelinoligodendrocyte glycoprotein 35-55 amino acid peptide (MOG35-55).The mice were randomly divided into a phosphate-buffered solution (PBS) group (n =7),an MSCs-Low group [n =7 which received an injection of 2× 105 mesenchymal stem cells (MSCs)],an MSCs-Med group (n=7,1× 106 MSCs),and an MSCs-High group (n=7,5×106 MSCs).Their clinical condition was then evaluated daily.On the 15th day after the MOG35-55 immunization,the different MSC doses were administered intravenously via the tail.On the 30th day the mice were sacrificed to observe any neuropathology of the spinal cord.At the same time,FACS flow cytometry was used to assay CD8+CD28-T cells in the spleen.Results Compared with the PBS control group,the MSC treatment effectively alleviated illness among the mice by the 15th day after the immunization.The maximum and average disease scores and clinical illness scores had all improved significantly.The medium dosage worked best.Neuropathological analysis showed that the MSC treatment could significantly reduce the invasion of inflammatory cells and minimize demyelination in the spinal cord.Furthermore,the CD8+ CD28-regulatory T cells in the spleens of the MSCtreated animals increased compared with the PBS control group,though the secreted levels of IL-10 showed no obvious difference.Conclusions Treatment with MCSs can promote the recovery of neural function in autoimmune encephalomyelitis,at least in mice.CD8+CD28-regulatory T cells may not be the main effector cells,playing only a synergistic therapeutic role.
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Staphylococcus epidermidis is the most important member of the coagulase-negative staphylococci and one of the most abundant colonizers of human skin.S.epidermidis is a bacterial species that is commonly described as relatively innoc-uous,which is in part due to the notion that it lacks secreted toxins with limited capability of infection.S.epidermidis pro-duces a series of molecules that provide protection from host defenses,including many proteins and exopolymers.Further-more,recent research has identified a family of cytolytic peptidesin S.epidermidis,the phenolsoluble modulins (PSMs),and the notion that S.epidermidis is virtually toxin-free had to be somewhat revised.
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Objective To study the effects of rehabilitation training on angiogenesis and its ultrastructure and expression of CD32 in the peri-infarction region of rats with focal cerebral infarction. Methods Sixty-six Spra-gue-Dawley rats with experimental left middle cerebral artery occlusion (MCAO) were used as subjects in this study. All the rats were randomly divided into three groups: a rehabilitation training group (n=30), which was given bar rotating, balancing and rolling exercises everyday after 48 hours post MCAO; a control group (n = 30) and a sham-operated group (n=6), which were fed in cages with no special training exercises. Then brain tissues were fixed on the 3rd d, 7th d, 14th d after MCAO, for observing the morphological alterations of microvessels in peri-infarction re-gion using transmission electron microscope, immunohistochemistry and Western blotting were used to measure the ex-pression of CD31, which acted as the marker of the neogenetic microvessels. Results (1) It showed that the capil-lary endothelial cells were less edematous in the rehabilitation training group, and there were less pinocytosis bullae in basal membrane more integral nucleus of endothelial cells in rehabilitation training group when compared with those in the control group. (2) Expression of CD31 can be observed in peri-infarction region in both groups from the 3rd d on-wards, and peaked on the 7th d, and then gradually went down after the 14th d. Comparison between the 2 groups showed that the expression of CD31 in rehabilitation training group was higher than that in the control group at every time point, but statistical difference between the 2 groups in this regard could be revealed only on the 7th d (P< 0.05), Conclusion Rehabilitation training could promote ultrastruetural recovery of microvessels and induce an-giogenesis in peri-infaretion region, and it might be one of the mechanisms of neural functional recovery in rats after MCAO.
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Objective To study the effects of rehabilitative training on motor function and expression of GAP-43 and SYN in rats with local cerebral infarction. Methods A total of 76 male adult Sprague-Dawley rats were randomly divided into a rehabilitative training group(n=32),a control group(n=32),and a sham-operated group(n=1 2).All the rats were subjected to left middle cerebral artery occlusion(MCAO)with the suture occlu sion.Motor training programs including balancing,grasping,rotating and walking exercises were administered to the rats of the rehabilitative training group at 48 hours post-operation,while those of other two groups were reared in their original living status without any special training.The animals were given behavioral tests with Bederson test,balancing wood test,net screen test to assess the functional outcome,and immunohistochemistry staining was employed to evaluate the exDression of GAP-43 and SYN in peri-infarction cortex at the 3rd,7th,21 st,35th days after MACO,respectively. Results The scores of behavioral tests in the rehabilitative training group was better than those in the control group(P＜0.05)at the 7th,21 st,35th day after MCAO,and the immunostaining showed that expression of GAP-43 was higher in the rehabilitative training group than that in the control group(P＜0.05)and the sham operated group(P＜0.01)at the 7th and 21 st days post-operation,respectively,and that the expression of SYN was higher in the rehabilitative training group than that in the control(P＜0.05)and the sham operated groups(P＜0.05)at the 21 st and the 35th days post-operation,respectively. Conclusion Rehabilitative training can improve func tional recovery in rats with local cerebral infarction,and the function enhancement may be partially attributed to the up-regulation of expression of GAP-43 and SYN in peri-infarction cortex.