ABSTRACT
Objective:To analyze levels of carnitine and acylcarnitine in peripheral blood from septic infants and to investigate their changes and clinical values in sepsis in infants.Methods:This retrospective research involved 46 septic infants and 55 infants with noninfectious diseases who were hospitalized in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine.The clinical data were collected, the levels of carnitine and acylcarnitine in peripheral blood measured by tandem mass spectrometry were compared between the two groups, and the correlations of acylcarnitine levels with CRP and PCT were analyzed respectively.The septic infants were divided into two groups according to whether there were complications or not.The levels of free carnitine and acylcarnitine were compared between the two groups.Results:The levels of C6DC, C14: 1, C14OH and C16OH in peripheral blood were significantly higher in septic infants than those with noninfectious diseases( Z=-2.52、-2.05、-2.68、-2.82, all P<0.05). There is no significant difference in free carnitine level between two groups.These four acylcarnitine levels were positively correlated with PCT( r=0.44、0.44、0.40、0.49, all P<0.01). In septic group, the percent of infants with abnormal levels of C16OH was significantly higher in infants with complications than those without complications( χ2=4.51, P<0.05). Conclusion:The peripheral blood levels of several acylcarnitine elevate in septic infants, and have positive correlations with the strength of infection.Meanwhile, there is a higher proportion of having abnormal level of long chain acylcarnitine among infants with complications than those without complications.These results suggest that lipid metabolism has changed in septic infants and detecting acylcarnitine levels can be helpful in assessing the severity of sepsis.
ABSTRACT
Current studies have found that breast milk contains multiple growth factors with important biological functions, which play an important role in growth and immune regulation in early life.Epidermal growth factor(EGF)can promote the proliferation and differentiation of neonatal gastrointestinal mucosa epithelium, and can prevent the development of necrotizing colitis.Transforming growth factors(TGF)include transforming growth factor α and transforming growth factor β.Transforming growth factor α is related to gastrointestinal function, while transforming growth factor β promotes IgA production and has immunomodulatory effect.Hepatocyte growth factor(HGF)can not only promote gastrointestinal tract development as a nutritional factor, but also may work as an immune factor to enhance immunity.Neurotrophic factors promote early neurogenesis in the offspring of preeclampsia mothers.At the same time, the content of these growth factors in breast milk is related to the gestational age, region, diet and other factors.This article summarizes the research progress and clinical application value of these growth factors.
ABSTRACT
Objective@#To investigate the effect of leading health education path on the clinical nursing of patients with atlantoaxial fracture.@*Methods@#A retrospective case control study was conducted to analyze 38 patients with atlantoaxial fractures admitted to our hospital from January 2017 to February 2018. There were 31 males and 7 females, aged 21-65 years [(49.6±12.5)years]. In the control group, there were 15 males and four females, aged 25-63 years [(48.6±15.3)years]. All patients underwent posterior atlantoaxial pedicle screw fixation. Among the patients in control group, there were eight with atlas fracture, four with axial fracture, and seven with atlantoaxial fracture, of which there were five patients of grade C and 14 of grade D according to the American Spinal Injury Association (ASIA) score. There were 16 males and three females, aged 21-62 years [(51.2±12.3)years] in the study group which adopted the leading health education path to provide patients step by step with knowledge of atlantoaxial fracture. In the study group, there were seven patients with atlas fracture, six with axial fracture, and six with atlantoaxial fracture, of which there were seven patients of grade C and 12 patients of grade D based on ASIA. The visual analogue score (VAS) at 1 week and 1 month after operation, Japanese Orthopedic Association (JOA) score at 1 and 6 months after operation, related knowledge mastery, nursing satisfaction, complication incidence, and ASIA grading improvement were compared between the two groups.@*Results@#The VAS was (2.1±1.3)points at one week after operation and (1.1±0.6)points at one month after operation in the study group, lower than those of control group [(3.4±2.4)points and (2.1±1.2)points] (P<0.05). The JOA score of the study group was (15.9±1.5)points, higher than that of the control group [(14.7±1.3)points] (P<0.05). The scores of knowledge mastery including basic knowledge, appropriate medication, complications prevention and functional exercise were (23.2±2.4)points, (24.1±1.7)points, (21.5±3.1)points and (22.8±1.6)points respectively in the study group, all of which were higher than those of control group [(14.4±3.1)points, (12.9±2.1)points, (15.4±4.3)points and (13.4±3.5)points] (P<0.05). The satisfaction with nursing in the study group was also higher than that of the control group (P<0.05). In the study group, one patient (5%) had pulmonary infection, and in the control group nine patients (47%) had complications including two with lower extremity vein embolism, four with urinary tract infection, two with pulmonary infection, and one with pressure injury (P<0.05). In the study group, there was one patient of grade C, five of grade D and 13 of Grade E according to ASIA; in the control group, there were two of grade C, six of grade D and 11 of Grade E (P>0.05).@*Conclusion@#The leading health education path for patients with atlantoaxial fracture to adopt staged treatment guidance is conducive to relieving pain and improving cervical function, reducing the incidence of complications, and deepening the mastery of relevant knowledge.
ABSTRACT
Objective@#To analyze the clinical characteristics and treatment of pseudohypoparathyroidism(PHP) in children and to increase clinicians′understanding of this disorder.@*Methods@#From January 2008 to November 2018, a total of 14 PHP patients at our hospital were retrospectively analyzed, as regarding the clinical manifestation, laboratory examination and imaging data.The patients were further divided into two groups according to onset age: group A(under 1 year) and group B(over or equal to 1 year). The laboratory findings were compared between the two groups.@*Results@#Of the 14 patients(10 boys and 4 girls), the median age of onset was 12 years(range: 1 day to 16 years). Epilepsy is one of the most common manifestations of PHP.Laboratory findings include hypocalcemia(1.06-2.18mmol/L), hyperphosphatemia(2.1-3.5 mmol/L), and elevated concentrations of PTH(105.6-733.0 pg/ml). PTH levels were significantly lower in the group A than in group B(Z=2.07, P=0.042). Five patients were found to have calcifications in bilateral basal ganglia and cerebral parenchyma by head CT.All the patients were improved after treatment, which included calcium gluconate injection to control tetany, calcium supplement combined with vitamin D and/or calcitriol orally.@*Conclusion@#For children who presented frequent hypocalcemia tetany and calcifications in head CT, serum calcium, phosphorus, PTH levels should be further investigated to make a correct diagnosis.Calcium supplement combined with vitamin D or its metabolites is an effective therapy for PHP children.
ABSTRACT
Objective To analyze the clinical characteristics and treatment of pseudohypoparathyroidism (PHP) in children and to increase clinicians'understanding of this disorder.Methods From January 2008 to November 2018,a total of 14 PHP patients at our hospital were retrospectively analyzed,as regarding the clinical manifestation,laboratory examination and imaging data.The patients were further divided into two groups according to onset age:group A (under 1 year) and group B (over or equal to 1 year).The laboratory findings were compared between the two groups.Results Of the 14 patients (10 boys and 4 girls),the median age of onset was 12 years (range:1 day to 16 years).Epilepsy is one of the most common manifestations of PHP.Laboratory findings include hypocalcemia (1.06-2.18mmol/L),hyperphosphatemia (2.1-3.5 mmol/L),and elevated concentrations of PTH (105.6-733.0 pg/ml).PTH levels were significantly lower in the group A than in group B (Z =2.07,P =0.042).Five patients were found to have calcifications in bilateral basal ganglia and cerebral parenchyma by head CT.All the patients were improved after treatment,which included calcium gluconate injection to control tetany,calcium supplement combined with vitamin D and/or calcitriol orally.Conclusion For children who presented frequent hypocalcemia tetany and calcifications in head CT,serum calcium,phosphorus,PTH levels should be further investigated to make a correct diagnosis.Calcium supplement combined with vitamin D or its metabolites is an effective therapy for PHP children.
ABSTRACT
Objective To investigate the effect of leading health education path on the clinical nursing of patients with atlantoaxial fracture.Methods A retrospective case control study was conducted to analyze 38 patients with atlantoaxial fractures admitted to our hospital from January 2017 to February 2018.There were 31 males and 7 females,aged 21-65 years [(49.6 ± 12.5) years].In the control group,there were 15 males and four females,aged 25-63 years [(48.6 ± 15.3) years].All patients underwent posterior atlantoaxial pedicle screw fixation.Among the patients in control group,there were eight with atlas fracture,four with axial fracture,and seven with atlantoaxial fracture,of which there were five patients of grade C and 14 of grade D according to the American Spinal Injury Association (ASIA)score.There were 16 males and three females,aged 21-62 years [(51.2 ± 12.3) years] in the study group which adopted the leading health education path to provide patients step by step with knowledge of atlantoaxial fracture.In the study group,there were seven patients with atlas fracture,six with axial fracture,and six with atlantoaxial fracture,of which there were seven patients of grade C and 12 patients of grade D based on ASIA.The visual analogue score (VAS) at 1 week and 1 month after operation,Japanese Orthopedic Association (JOA) score at 1 and 6 months after operation,related knowledge mastery,nursing satisfaction,complication incidence,and ASIA grading improvement were compared between the two groups.Results The VAS was (2.1 ± 1.3) points at one week after operation and (1.1 ± 0.6) points at one month after operation in the study group,lower than those of control group [(3.4 ± 2.4) points and (2.1 ± 1.2) points] (P ＜ 0.05).The JOA score of the study group was (15.9 ±1.5) points,higher than that of the control group [(14.7 ± 1.3) points] (P ＜ 0.05).The scores of knowledge mastery including basic knowledge,appropriate medication,complications prevention and functional exercise were (23.2 ± 2.4) points,(24.1 ± 1.7) points,(21.5 ± 3.1) points and (22.8 ±1.6) points respectively in the study group,all of which were higher than those of control group [(14.4 ±3.1)points,(12.9 ±2.1)points,(15.4 ±4.3) points and (13.4 ±3.5)points] (P＜0.05).The satisfaction with nursing in the study group was also higher than that of the control group (P ＜ 0.05).In the study group,one patient (5％) had pulmonary infection,and in the control group nine patients (47％) had complications including two with lower extremity vein embolism,four with urinary tract infection,two with pulmonary infection,and one with pressure injury (P ＜ 0.05).In the study group,there was one patient of grade C,five of grade D and 13 of Grade E according to ASIA;in the control group,there were two of grade C,six of grade D and 11 of Grade E (P ＞ 0.05).Conclusion The leading health education path for patients with atlantoaxial fracture to adopt staged treatment guidance is conducive to relieving pain and improving cervical function,reducing the incidence of complications,and deepening the mastery of relevant knowledge.
ABSTRACT
Objective To investigate the treatment of infant wheezing during acute phase in the pediatric out-patient departments of two tertiary hospitals and two secondary hospitals in Shanghai.Methods Simple random sam-pling method was adopted.Standardized questionnaires were given to the parents and physicians of infants who suffered wheezing during the acute phase to survey the treatment methods in the pediatric outpatient departments of two tertiary hospitals(Xinhua Hospital,Shanghai Children's Medical Center)and two secondary hospitals(Putuo District People's Hospital,Renhe Hospital)from February to May 2015 in Shanghai area.All data were analyzed by using SPSS 20.0 software.The enumeration data were used to describe the frequency distribution,composition ratio,and the rates among different groups were compared by the χ2test.Results The survey questionnaires were withdraw from 264 cases,of which 166 were boys and 98 were girls.In the treatment of acute exacerbation,the rate of antibiotic use was 94.7%(250/264 cases),in which 67.0%(177/264 cases)were intravenous drugs;62.1%(164/264 cases)patients were using inhaled glucocorticoid and short-acting beta-agonists as the main drugs for treatment;the ratio of systemic glu-cocorticoid using was 52.3%(138/264 cases),and the ratio of intravenous method was 43.2%(114/264 cases) among the cases.The usage ratio of systemic beta-agonist,anti-leukotrienes and antihistamines were 83.0%(219/264 cases),30.3%(80/264 cases)and 41.3%(109/264 cases),respectively.Of the 206 cases with respiratory in-fection,the rate of antibiotics use reached 98.5%(203/206 cases),and among the 58 cases without respiratory infec-tion,and the rate of antibiotics use acounted to 84.5%(49/58 cases).The difference between the two groups was sta-tistically significant(χ2=20.6,P<0.01). There were 200 cases of children with atopic physique background,of whom,42.5%(85/200 cases)were treated with antihistamine and 34%(68/200 cases)were treated with anti-leu-kotriene drugs.There were 64 cases without atopic physique background,of whom,37.5%(24/64 cases)were treated with antihistamine and 18.8%(12/64 cases)were treated with anti-leukotriene drugs.The proportion of anti-leuko-triene drug use in children with atopic physique background was significantly higher than that in children without atopic physique background,and the difference between two groups was statistically significant(χ2=5.34,P<0.05).Except for antihistamine treatment,the distribution of other treatments in different hospitals or outpatient departments was simi-lar(all P>0.05).Conclusions Nebulized glucocorticoid and beta-agonist therapy has become the routine treatment for infant wheezing in the acute phase in the tertiary and secondary level hospitals in Shanghai.The treatment of infant wheezing needs to be further standardized since the use of antibiotics,systemic glucocorticoids and intravenous drugs is excessive.
ABSTRACT
Objective To study the differences of clinical manifestations,etiology and hospitalized outcomes of purulent meningitis in preterm and term infants.Method All preterm and term infants with purulent meningitis hospitalized in the Hospital from 2006 to 2015 were enrolled in this study.The data of neonate's condition,maternal condition,clinical manifestations,complications,etiology,treatment and outcomes of the preterm and term infants groups were compared.Result During the study period,44 preterm infants and 118 term infants were included.The time of onset for purulent meningitis of preterm infants group was statistically earlier than that of term infants group [11.2 (3.2,19.8) d vs.14.3 (5.6,23.9) d,P ＜ 0.05].The prognosis of preterm infants group was statistically worse than that of term infants group (P ＜ 0.05).Among them,the incidences of clinical manifestations in preterm infants group compared to term infants group were:fever (54.5％ vs.78.8％),seizure (11.4％ vs.26.3％),lethargy and poor response (59.1％ vs.38.1％),slow weight gain (9.1％ vs.0％),apnea (45.5％ vs.0.8％) and cyanosis (15.9％ vs.4.2％);all the differences between two groups were significant (P ＜ 0.05).The time of onset for purulent meningitis with complications was statistically earlier than those without complications [9.5 (4.1,20.5) d vs.13.8 (5.9,22.0) d,P＜0.05].The duration of treatment for purulent meningitis with complications was longer than that without complications [(42.2 ± 8.8) d vs.(28.7 ± 7.1) d,P ＜ 0.05],and the positive rate of pathogens was also statistically higher than those without complications (73.8％ vs.26.7％,P ＜0.05).Coagulase-negative staphylococcus was the main pathogen for both preterm and term infants group.Klebsiella pneumoniae was more common in preterm infants group than in term infants group (40.0％ vs.10.4％,P ＜0.05).Conclusion Preterm infants with purulent meningitis had early onset time,atypical clinical manifestations,and poor prognosis.The treatment course for purulent meningitis with complications is prolonged.The pathogens for neonatal purulent meningitis have already changed.The detection rate of conditional pathogens is increasing yearly,for which the clinicians should take note seriously.
ABSTRACT
Objective To study the occurrence of nosocomial infection ( NI ) situation in the neonatal intensive care unit ( NICU ) of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2012 to October 2013,and analyze risk factors of NI. Methods A retrospective study was per-formed in the NICU,of which all neonates hospitalized over 48 hours were included and the occurrence situation and risk factors of NI were analyzed. Results This study included 1 357 neonates,and 175 neonates developed 202 times NI. The overall incidence of NI was 14. 89% (202/1 357),and the incidence density was 10. 44 per 1 000 NICU patient-days (202/19 355). The lower the birth weight is,or the smaller gestational age is,the higher the NI rate is. The NI rate was 75. 00% in neonates whose birth weight <1 000 g,and the NI rate was 52. 63%in neonates whose gestational age <30 weeks. The most common infection type was pneumonia[43. 07% (87/202)]and sepsis[26. 73% (54/202)]. The hospital stay of the NI neonates was longer and the cost of hospitali-zation is higher than non-NI neonates ( Median stay:20 days and 10 days. Median cost:21 045. 32 yuan and 8 108. 23 yuan)(both P<0. 01). Univariate analysis showed there were significant differences between NI neo-nates and non-NI neonates on gestational age,birth weight,5 min Apgar score,asphyxia rescue history,previons antibiotics use,mechanical ventilation,peripherelly inserted central catheter( PICC) ,closed thoracic drainage tube and chest or abdominal surgery before NI. The logistic regression analysis indicated that previous antibiotics use, mechanical ventilation and PICC were important risk factors for NI. Conclusion The NI rate in NICU is still high. Previous antibiotics use,mechanical ventilation and central venous catheter are risk factors of NI.
ABSTRACT
ObjectiveTo explore the risk factors for the prognosis of respiratory failure in neonates with gestational age≥34 weeks. MethodsA total of 143 hospitalized neonates with respiratory failure who had gestational age≥34 weeks were enrolled from Jan. 2011 to Jun. 2013. According to the outcome, the neonates were divided into good prognosis group and poor prognosis group. The risk factors for the prognosis of respiratory failure were screened by univariate analysis and mul-tivariate binary logistic regression model.ResultsAmong the 143 neonates, 105 neonates had good prognosis and 38 neonates had poor prognosis. Univariate analysis showed that the mode of delivery, small for gestational age, 5 minutes Apgar score <7, and with primary disease being pneumonia/sepsis were associated with a poor prognosis. The differences were statistically signif-icant (P<0.05). Furthermore, the multivariate binary logistic regression model showed that, small for gestation age (OR=23.87, 95%CI:3.149-180.9) and pneumonia/sepsis (OR=2.996, 95%CI:1.514-5.928) were the independent factors of poor prognosis. ConclusionsSmall for gestation age and primary diseases being pneumonia/sepsis are the independent factors inlfuencing prog-nosis of respiratory failure in neonates born at a gestational age≥34 weeks.
ABSTRACT
Objective To apply 3C3R model in problem design of PBL for pediatrics teaching.Methods The 3C3R model comprises two classes of components:core components and processing components.Core components of the model are 3C,which are content,context and connection while processing components are 3R,which are researching,reasoning and reflecting.3C3R model was used in the problem design for the PBL case of ‘ Why the mouth of Baobao became purple when he was crying?' Totally 76 eight-year program medical students and 7 tutors were enrolled as teaching object.The anonymous questionnaires from the students were collected for assessment of PBL teaching.Results The percentage of students with scores ≥4 for content in PLB problem design was 90.8％,for context was 80.3％,for connection was 64.5％,for researching was 81.6％,for reasoning was 69.7％ and for reflecting was 40.8％.The percentage of tutors with scores ≥4 for content in PLB problem design was 100％,for context was 71.4％,for connection was 28.6％,for researching was 71.4％,for reasoning was100％,for reflecting was57.1％.Both students and tutors held a positive attitude towards the component of content,context,researching and reasoning in problem design model.But the components of connection and reflection needed to be improved.Conclusion The 3C3R model is helpful for problem design of PBL in pediatric teaching.
ABSTRACT
Objectives To investigate the incidence of brain injuri in premature infants in ten hospitals of seven large cities in China sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association. Methods All premature infants with gestational age less than 37 weeks in ten hospitals were given routine cranial ultrasound within three days of birth, and then repeated every 3-7 days till the discharge from the hospital during January 2005 to August 2006. Results Incidence of intraventricular hemorrhage (IVH) and severe IVH were 10.8% (406/3 768) and 2.4% (92/3 768) with 22.6% (92/406) for grade 1, 54.7% (222/406) for grade 2, 17.2% (70/406) for grade 3 and 5.4% (22/406) for grade 4 in nine hospitals; incidence of periventricular leukomalacia (PVL) and cystic PVL were 2.3% (112/4 933) and 0.3% (16/4 933) with 85.7% (96/112) for grade 1, 12.5% (14/112) for grade 2, and 1.8% (2/112) for grade 3 including all ten hospitals, respectively. Risk factors associated with increased severity of IVH were vaginal delivery (OR = 1.874, 95% CI = 1.172 - 2.997, P < 0.01), perinatal asphyxia (OR = 1.598, 95% CI = 1.077 - 2.372, P < 0.05), mechanical ventilation (OR = 3.988, 95% CI= 2.448 -6.948, P< 0.01), and amniotic fluid contamination (OR = 2.192, 95% CI = 1.054 - 4.544, P< 0.05). Risk factors that might result in the development of cystic PVL were vaginal delivery (OR = 1.400, 95% CI = 1.186 - 1.652, P < 0.001) and mechanical ventilation (OR = 3.000, 95% CI = 1.015 - 8.864, P < 0.05). Conclusions These data reflect basically the prevalence of brain injuriy in premature infants in major cities of China. However, more than 60% of population lives in the rural area, further multicenter investigation including the rural area is expected to be undertaken in future.
ABSTRACT
Objective In order to know the fatty acid content of breast milk in different regions of China. Methods The fatty acid composition of breast milk from 109 lactating women in three regions was analyzed by capillary gas chromatography. Twenty-seven milk samples were obtained from Shanghai urban, 15 samples from Shanghai suburb(Chongming county) and 67 samples from Zhoushan island of Zhejiang province. Results The contents of linoleic acid(LA) and ?-linolenic acid(LNA) in the mature breast milk from Shanghai urban women were (29?6)% and (2.8?0.7)%, respectively, which were significantly higher than that from Shanghai suburb women[LA, (20?3)% and LNA,(2.7?0.8)%] and Zhoushan island women[(20?3)% and (2.5? 0.6)%], whereasthe DHA content of the breast milk from Zhoushan women was (0.61?0.21)%, which was significantly higher than that from Shanghai urban women[(0.51?0.25)%, P
ABSTRACT
Objective:To determine aristolochic acid A. in Caulis Aristolochiae Manshuriensis and its preparation. Methods: TLCS Refleciton Saw Tooth Method was used. ? s=323nm. narrow slot: 0.4?0.4nm S X=3.Results: The recovery was 99.86%. RSD was 2.04%. Conclusion: This method is suitable for the content determination of aristolochiae acid A in various traditional Chinese medicine comprising Caulis Aristolochiae Manshuriensis.