Clinical characteristics and outcomes of respiratory distress syndrome in term and late-preterm neonates / 中华儿科杂志

<p><b>OBJECTIVE</b>Respiratory distress syndrome (RDS) is a frequently seen acute respiratory disorder in the newborn infants. Since the original description of deficiency of the pulmonary surfactant in premature neonates by Avery in 1959, RDS has most commonly been attributed to developmental immaturity of surfactant production. But in clinical practice it has been found that there was RDS in term and late-term neonates. Many of them were recognized as transient tachypnea at the beginning, they were diagnosed as RDS until respiratory distress and the typical radiological signs were demonstrated. The purpose of this study was to investigate the clinical characteristics of RDS of term and late-term neonates.</p><p><b>METHODS</b>All neonates admitted to the neonatal intensive care unit of the Children's Hospital, Zhejiang University School of Medicine between May, 2005 and May, 2007 on the basis of RDS were analyzed. RDS was diagnosed when respiratory distress and the typical radiological signs were documented. Patients were grouped into preterm group (Group 1, gestational age < 35 w, n = 103) and term and late-term group (Group 2, gestational age > or = 35 w, n = 74).</p><p><b>RESULTS</b>In Group 1, 76 preterm infants were male, the mean gestational age was 31.1 w, the mean Apgar score at 1 min was 7.6, the mean birth weight was 1702 g, 56 cases were vaginally delivered and 47 were delivered through Cesarean section. Only one was delivered via elective Cesarean section before onset of labor. A total of 88 patients needed mechanical ventilation (MV), the time for beginning MV was 8.7 h (1 - 72 h), and lasted for 4.3 d (0.5 - 29 d). The oxygenation index (OI) was 11.9 (10.00 - 52.63) and PaO2/PAO2 was 0.29 (0.03 - 0.98). Four patients had an OI > 40. A total of 28 patients were treated with pulmonary surfactant (PS), and 11 of the 28 underwent MV, the OI before and 2 h, 8 - 12 h and 20 - 24 h after using PS were 10.5, 5.4, 3.4, and 4.3, respectively (P < 0.01). A total of 33 patients in Group 1 had intracranial hemorrhage, 4 patients had pneumothorax, 4 patients had persistent pulmonary hypertension of the newborn (PPHN) and 15 patients had ventilator associated pneumonia (VAP). In Group 2, 54 infants were male, the mean gestational age was 37 w, the mean Apgar score at 1 min was 8.5, the mean birth weight was 2789 g, 8 cases were vaginally delivered, 66 were delivered through Cesarean section and 59 were delivered via elective Cesarean section before onset of labor. A total of 63 patients needed MV, the time for beginning MV was 27.8 h (1 - 72 h, compared to Group 1, P < 0.01), and lasted for 3.7 d (0.5 - 13.5 d). The OI was 19.70 (10.00 - 56.67, compared to Group 1, P < 0.01) and PaO2/PAO2 was 0.16 (0.017 - 0.470, compared to Group 1, P < 0.01). Seven patients had an OI > 40. A total of 8 patients were treated with PS and 7 of them had MV, the OI before and 2 h, 8 - 12 h and 20 - 24 h after using PS were 11.2, 7.6, 7.5, and 7.6 (the last two compared to group 1, P < 0.01, respectively). A total of 16 patients had pneumothorax, 10 patients had intracranial hemorrhage, 16 patients had PPHN and 7 patients had VAP.</p><p><b>CONCLUSION</b>Most of the term and late-term neonates who developed RDS were delivered through cesarean section before onset of labor. They underwent MV later. The oxygenation was worse than RDS in preterm infants. PS did not have the same effect as seen in preterm infants. They had more pneumothorax and PPHN.</p>

Application of flow cytometry to detect PP65 antigenemia for diagnosis and monitoring of human cytomegalovirus infection / 中华儿科杂志

<p><b>OBJECTIVES</b>To evaluate the clinical significance of flow cytometry (FCM) to detect the cytomegalovirus (CMV) PP65 antigen in patients with CMV infection.</p><p><b>METHODS</b>Samples from 35 patients without CMV infection were used as negative control. The definite diagnosis of CMV infection was based on the national criteria for CMV infection. All 136 patients with CMV infection were examined with the FCM to detect CMV PP65 antigen, real-time fluorescence quantitative-polymerase chain reaction assay (RFQ-PCR) to detect CMV-DNA and ELISA to measure the serum level of IgM antibody against CMV. The results of these 3 assays in 2 groups (isolated organ involvement and disseminated diseases) were compared and the significance of PP65 antigenemia was evaluated. A short-term follow-up was undertaken in 18 patients.</p><p><b>RESULTS</b>The percentages of PP65 positivity in blood mononuclear cells (MNC) and polymorphic nuclear leukocyte (PMNL) from 35 negative control patients were 0.21% +/- 0.09% with a range of 0 - 0.41% and 0.24% +/- 0.10% with a range of 0.12% - 0.48%, respectively, which were not significantly different (t = 0.425, P > 0.05). The 95(th) percentiles (P(95)) of PP65 in MNC and PMNL were 0.39% and 0.45%, respectively, so a cutoff value of >/= 0.50% was set. Of the 136 patients with CMV infection, 118 samples from 118 patients were positive for PP65 antigenemia with a positive rate of 86.8%, which was not statistically different from that (90.4%, chi(2) = 0.91, P > 0.05) of CMV-DNA detected by RFQ-PCR assay but it was significantly higher than that (45.6%, chi(2) = 51.50, P < 0.005) of the detection by IgM measurement. PP65 detection was correlated with urine CMV DNA amplification (chi(2) = 63.78, P < 0.01) while the different detection rates between the two assays were not statistically significant (chi(m)(2) = 1.78,P > 0.05). PP65 detection was not correlated with serum IgM measurement while the detection rates between the two were significantly different (chi(m)(2) = 52.92,P < 0.01). No significant difference was found between the detection rates of CMV infection in MNC (45/53, 84.9%) and PMNL (43/53, 81.1%) (chi(m)(2) = 0.25, P > 0.05). Higher PP65 antigenemia level was correlated with systemic CMV infection, while lower level of PP65 was either in the patients with isolated organ involvement by CMV (chi(2) = 38.51, P < 0.005) or less severe in patient's situation. PP65 antigenemia of CMV infection returned to lower level or negative in recovery stage and increased when condition of patients deteriorated.</p><p><b>CONCLUSIONS</b>PP65 antigenemia detection by FCM is effective in the diagnosis of the active CMV infection. Quantitative monitoring of PP65 antigenemia is useful in the evaluation of patients with CMV infection.</p>

Effects of phytoestrogens on gap junctional intercellular communication / 中华预防医学杂志

<p><b>OBJECTIVE</b>To observe effects of phytoestrogens quercetin (QC), Genistein (GEN), coumestrol (COM), and enterolactone (ENL) on gap junctional intercellular communication (GJIC) in HaCaT cells.</p><p><b>METHODS</b>HaCaT cells were exposed to QC, GEN, COM, and ENL at 0.1, 1.0, 10.0 and 100.0 micromol/L for 24 hours. The effects of phytoestrogens on GJIC were determined by fluorescence redistribution after photobleaching (FRAP) technique of using a laser scanning confocal microscope (LSCM).</p><p><b>RESULTS</b>QC did not affect the GJIC at 0.1-10.0 micromol/L, whereas, GEN, COM, and ENL exhibited inhibition on the GJIC in some extent at 0.1-10.0 micromol/L without showing significant cytotoxicity. The ratio of fluorescence recovery were between 31.77% to 37.06%, which were significantly decreased compared the vehicle control (44.74%).</p><p><b>CONCLUSION</b>The phytoestrogens GEN, COM, and ENL, but not QC, could inhibit the GJIC function in HaCaT cells at concentrations could be reached in human serum in some instance, indicating they could, under certain conditions, be cancer promoters. Therefore, it should be prudent to use these chemicals as pharmaceuticals or dietary supplements.</p>

Relationship among serum cortisol and insulin and blood glucose in the asphyxiated neonates / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the dynamic change of serum cortisol and insulin levels, and their relation with blood glucose concentration in asphyxiated neonates.</p><p><b>METHODS</b>The levels of serum cortisol and insulin at d1,d3 and d7 of birth were measured by radioimmunoassay and the concentration of blood glucose was measured with glucose oxidase method in 43 asphyxiated neonates.</p><p><b>RESULTS</b>The levels of serum cortisol at d 1, d 3 and d 7 of birth were gradually decreased (P<0.01). At d1, the incidence of hyperinsulism (>20 mIU/L) was 60.5%. The level of serum insulin reached normal level (<or=20 mIU/L) at d 3. At d 1, the level of serum cortisol was positively related with the level of blood glucose (r=0.432, P<0.01), the ratio of serum insulin and cortisol in hypoglycemia group (0.71+/-0.71) was significantly higher than that in normal blood glucose group (0.19+/-0.36, P<0.01). The incidence of hypoglycemia in hyperinsulism group was markedly higher than that in normal serum insulin group (P<0.05).</p><p><b>CONCLUSION</b>There are temporary hyperinsulism in asphyxiated neonates. Hypoglycemia in asphyxiated neonates is related with hyperinsulism and low serum cortisol level.</p>

Pathogen and spectrum of disease in infants with human cytomegalovirus infection / 中华传染病杂志

Objective To investigate the correlation between pathogens and spectrum of disease in infants with human cytomegalovirus(HCMV) active infection.Methods A total of 378 cases of HCMV infection diagnosed by the identification of HCMV IgM or PP65 antigen of HCMV.HCMV gB genotyping was carried out by nested PCR and restriction fragment length polymorphism(RFLP) in 107 cases.The results of pathogen,spectrum of disease and clinic feature were analyzed.Results In all 378 infant patients with HCMV,27.78% were systemic infection and 72.22% involved just single organ.Hepatitis,HCMV inclusion disease,thrombocytopenic purpura,pneumonia were pre- dominant with 33.07%,27.78%,13.49%,6.35% respectively.The rate of HCMV inclusion dis ease in infants younger than 2 weeks was higher than in those aged from 3 12 weeks(P ~ 0.05) and children older than 12 weeks(P＜0.01).Infants with higher rate of PP65 antigen positive cells were apt to systemic infection than those with lower rate of PP65 positive cells(P＜0.01).Infants,who were positive by detections of all three methods,were apt to systemic infection than others(P＜0.01). Moreover,infants positive of IgM and PP65 antigen were apt to systemic infection than those just positive by one of the two methods(P＜0.01).The result of gB genotype analysis in 107 cases showed 53 cases of gBⅠ,20 of gBⅡ.18 of gBⅢ.7 of gBⅠ+gBⅡ,5 of gBⅠ+gBⅢand 4 of gBⅡ+gBⅢ,and gBⅣwas not found.Conclusion HCMV could infect multiple organs and have some different clinic features.Combination of different methods can increase the sensitivity to detect the pathogen.The gBⅠgenotype is most prevalent in these infants.