Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China / 中华医学杂志(英文版)

BACKGROUND@#Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.@*METHODS@#The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD.@*RESULTS@#A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082-4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606-3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044-1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061-2.424), DRI (OR, 2.094; 95% CI, 1.328-3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679-4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777-6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996-0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379-0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160-0.467) were preventive factors for BPD (all P < 0.05).@*CONCLUSION@#Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

Preparation of antibody against mouse UPF1 and the expression of UPF1 in adipose cell differentiation / 基础医学与临床

Objective To prepare polyclonal antibodies against mouse UPF1 protein and to investigate the expression of UPF1 protein during adipocyte differentiation. Methods UPF1 protein expression vector was constructed to prepare and purify rabbit UPF1 antibody. The differentation of 3T3-L1 cells was induced and the expression of UPF1 was detected by CoIP. Results 1)High specific mUPF1 polyclonal antibody was prepared and the titer of this anti-body reached 640 000;2)The expression of UPF1 protein did not change during adipogenesis;3)In the process of adipocyte differentiation,interaction of UPF1 and UPF2 was increased. Conclusions 1)The polyclonal antibodies prepared by using 550 amino acids at the C terminal of mUPF1 protein could effectively recognize intact mUPF1 pro-tein;2)The interaction of UPF1 protein with UPF2 protein during adipocyte differentiation is enhanced.

Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects and safety of traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children.</p><p><b>METHODS</b>From October 2012 to May 2016, 65 patients with proximal humeral fractures were treated with traditional manipulative reduction and percutaneous elastic intramedullary nail fixation. There were 52 boys and 13 girls, ranging in age from 7 to 14 years old, with an average age of 11.2 years old. Twenty-three patients had injuries on the left side, and 42 patients had injuries on the right side. There were 13 cases of oblique fracture, 49 cases of transverse fracture, and 3 cases of comminuted fracture. All the patients had closed, obviously displaced fractures, without vascular and nerve injuries. The duration from injury to treatment ranged from 20 minutes to 5 days, with a mean of 3 days. The fracture healing and complications were observed after operation, and the curative effect was evaluated by Neer shoulder function score.</p><p><b>RESULTS</b>The operation time ranged from 30 to 40 minutes, with a mean of 35 minutes; intraoperative blood loss ranged from 5 to 10 ml, with a mean of 6.5 ml. All the patients were followed up, and the duration ranged from 12 to 28 months, with an average of 18 months. All the fractures healed. According to the Neer evaluation system, 59 patients got an excellent result, 5 good and 1 fair. Four patients had a small amount of secretions on the tail of the needle; 2 patients had skin irritation; 1 patient had partial withdrawal of the nail, and the skin in all the patients healed after taking out the nail. No patients had nonunion fractures due to the broken nails and loosen screws, and no vascular or nerve injuries occurred.</p><p><b>CONCLUSIONS</b>Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children has the advantages of less trauma, quicker recovery, less complications and simple operation.</p>

Treatment of intertrochanteric fractures in the advanced age patients by external fixators / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effect of external fixators on the intertrochanteric fracture in the advanced age patients.</p><p><b>METHODS</b>From June 2008 to September 2010,32 cases who failed to be operated by the regular open-sugery were divided into two groups randomly, 16 of those were put in traction and conservative treatment;and the other 16 patients were treated by external fixation under anesthetization. In the traction group, there were 9 males and 7 females with an average age of (79.19 +/- 1.83) years ranging from 78 to 85. In the external fixation group, there were 10 males and 6 females with an average age of (79.69 +/- 2.41) years ranging from 78 to 88 years. Acoording to the Evans-Jensen classification,in the traction group, there were 6 cases of type I ,6 cases of type II, 7 cases of type III and lieing in bed 45 days in average; in the external fixation group, there were 6 cases of type I ,5 cases of type II, 2 cases of type III, 2 cases of type IV, and non-weight loading walking after surgery in a week in average.</p><p><b>RESULTS</b>In the traction group, 3 of them had decubitus, 3 of them had cardiopulmonary insufficiency, 2 of them had infection from traction needles, and 1 of them had pneumonia; in the external fixatioin group, only 2 of them had coxa vara. Based on the Harris scoring for the assessment of the function of hip join,in the traction group, the results were excellent in 4 cases,good in 3,fair in 3,poor in 6; in the external fixation group,the results were excellent in 10 cases, good in 3, fair in 2, poor in 1.</p><p><b>CONCLUSION</b>Thus, the use of external fixation on the intertrochanteric fracture is a strong safe and effective method in treating intertrochanteric fracture of the advanced age patients.</p>

Management of thyroglossal duct carcinoma: report of five cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristic, diagnosis, surgical treatment and prognosis of thyroglossal duct carcinoma (TDCa).</p><p><b>METHODS</b>A total of 110 patients with thyroglossal duct remanat in our hospital between 1991 and 2011 was reviewed. Five patients of them were diagnosed with TDCa by pathological examination, including 4 cases of papillary carcinoma and 1 case of squamous cell carcinoma.</p><p><b>RESULTS</b>All five patients were men and the median age was 41 years (range from 17 - 73 years). Pulmonary metastasis was found preoperatively in one patient with papillary carcinoma. All five patients were managed by surgical treatment. Sistrunk operation was performed with resection of the tumor, thyroglossal remanat and partial hyoid bone in 2 patients, with resection of thyroid nodule in one patient, with total thyroidectomy and central neck dissection in one patient with pulmonary metastasis, with extensive resection of invading tissues in one patient with squamous TDCa. Two patients with papillary carcinoma underwent the treatment with TSH suppression postoperatively, of them one with pulmonary metastasis received radioactive iodine therapy simultaneously. The remaining three patients did not receive any further treatment. With follow-up of 14 - 45 months, local recurrence occurred in one patient with squamous TDCa after two months and caused death seven months after surgery, and the other four patients survived.</p><p><b>CONCLUSIONS</b>TDCa is a rare malignant tumor that is usually diagnosed after surgery. The Sistrunk operation may be adequate for low-risk cases.</p>

Functional reconstruction after total or near total glossectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the functional outcomes of patients who underwent total or near total glossectomy with pectoralis major myocutaneous flap (PMMF) or free flap (FF) reconstruction.</p><p><b>METHODS</b>Retrospective study of 38 consecutive patients undergoing total or near total glossectomy with PMMF or FF reconstruction. The outcomes of decannulation, feeding and speech function recovery were compared.</p><p><b>RESULTS</b>Near total glossectomy was performed in 33 patients and total glossectomy was performed in 5 patients. Twenty five patients underwent reconstruction with PMMF including 2 salvage reconstructions after free flaps failure. All PMMFs survived except one complete necrosis. The success rate of PMMF was 96.0% (24/25). Fifteen patients underwent reconstruction with FF. Two flaps developed complete necrosis and the success rate of FF was 86.7% (13/15). The difference in the rates between the two groups was not significant (P=0.545). In the PMMF and FF groups, the renewal of oral feeding were 65.2% (15/23) and 100% (13/13), P<0.05, and the tracheostomy decannulation were 52.2% (12/23) and 100% (12/12), P<0.05, respectively. Postoperative feeding function recovery was better in FF group than that in PMMF group (P=0.011). Single factor analysis showed that using FF and maintaining the continuity of the mandible were related to successful rate of renewal of oral feeding. Multivariate Logistic regression analysis showed that the continuity of the mandible was the only independent predictor for renewal of oral feeding. There was no significant difference in the postoperative speech functions between the two groups.</p><p><b>CONCLUSIONS</b>The continuity of the mandible is the major factor to restore the functional outcomes in feeding after total or near total glossectomy. Compared with PMMF, using FF is more beneficial to retain or rebuild the continuity of the mandible.</p>

Lateral superior genicular flap combined with Tuihuang xiaozhong decoction for the treatment of soft tissue defects around the knee joint / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the early combination of Chinese and Western medicine for anti-inflammation and lateral superior genicular flap for the treatment of soft tissue defects around the knee joint.</p><p><b>METHODS</b>From June 2004 to September 2008, 8 patients with soft tissue defects around the knee joint were treated with lateral superior genicular flap. Among the patients, 5 patients were male and 3 patients were female, ranging in age from 32 to 56 years, with an average of 35.2 years. The defected area ranged from 7.6 cm x 4.5 cm to 15.2 cm x 7.5 cm. The disease course ranged from 3 months to 3 years. Three patients had the defects at the posterior of the knee, 2 patients had the defects at the popliteal fossa, and 3 patients had the defects at the lateral side of the knee. At the early stage, all the patients were treated with Tuihuang Xiaozhong decoction and antibiotics for 3 to 5 days.</p><p><b>RESULTS</b>All the flaps survived, and the knee function recovered. One patient had epidermis necrosis at the distal end of the flap of lateral side of the knee.</p><p><b>CONCLUSION</b>The early combination of Chinese and Western medicine for anti-inflammation is a simple, easy to promote, and no special microsurgical instruments are needed.</p>

Central compartment lymph node metastasis in cN0 papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the incidence and the predictive factors for the metastasis of central compartment lymph nodes (level VI) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC).</p><p><b>METHODS</b>One hundred and eight patients with cN0 PTC underwent neck dissection for level VI between January 2003 and December 2006 were followed up and analyzed retrospectively. Univariate analysis with the χ² test was used to analyze the statistical correlation between central compartment lymph nodes metastasis and the other clinical factors. Multiple Logistic regression analysis was used to identify the multivariate correlates of central compartment metastasis. Kaplan-Meier method was used to calculate the accumulative survival rate, lateral neck recurrence and metastasis rate.</p><p><b>RESULTS</b>Metastasis rate in level VI was 59.2% (64/108). Age below 45, tumor size > 3 cm and extracapsular spread were independent predictive factors for the metastasis in level VI (odds ratio were 5.514, 5.610 and 3.122, P < 0.05, respectively). There were low incidence of postoperative complications, 2 cases with transient nerve palsy (1.8%), 5 cases with transient hypoparathyroidism (4.6%) and 1 case with permanent hypoparathyroidism (0.9%). Six cases with ipsilateral neck recurrence, 1 case died. The 5-year lateral neck recurrence rate and accumulative survival rate were 4.8% and 99.1% respectively.</p><p><b>CONCLUSION</b>Metastasis in level VI in the patients with cN0 PTC is common and selective neck dissection is necessary for the patients.</p>

Measurement of brain regional oxygen saturation in neonates in China: a multicenter randomized clinical trial / 中华儿科杂志

<p><b>OBJECTIVES</b>To understand the value of measuring neonatal cerebral regional oxygen saturation (rSO2) using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation, to establish the normal range of neonatal cerebral rSO2 and to collect data of the changes of cerebral rSO2 under certain disease status.</p><p><b>METHODS</b>Nine large hospitals participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008. Using the NIRS human tissue oximeter (TSAH-100) independently developed in China, the cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any special disease, was detected at 1, 2 and 3 days after birth, respectively. The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation, was also detected during the severe phases. The pulse oxygen saturation (SpO2) measured at the finger tip, and also the arterial oxygen saturation (SaO2) measured by blood gas analysis, which could indicate the oxygen supply of the whole body, were obtained simultaneously. The correlations among cerebral rSO2, pulse SpO2 and arterial SaO2 were analyzed.</p><p><b>RESULTS</b>(1) The cerebral rSO2 of the normal full-term neonates was (62+/-2)%. Cerebral hypoxia was defined as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F=0.610, P>0.05). The cerebral rSO2 of the neonates with diseases was (55+/-7)%, which was significantly lower than that of the normal full-term neonates (t=15.492, P<0.05). (2) The cerebral rSO2 was positively correlated with the SpO2 (r=0.74, P<0.01) and the SaO2 (r=0.71, P<0.01). (3) Under some special diseases, the changes of cerebral rSO2 was asynchronous with those of the SpO2: (1) For 18 cases under severe cerebral damages or under relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%-58%), but the SpO2 was still normal (above 90%). (2) During the recovery of some critically ill neonates, the increase of cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%-80% for SpO2, and 44%-50% for cerebral rSO2); when the diseases were alleviated, although the SpO2 recovered to above 85%, the cerebral rSO2 was still significantly low (around 50%). (3) In 3 cases, during the severe phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%-72%, which was significantly higher than the normal value (62%).</p><p><b>CONCLUSIONS</b>The range of cerebral rSO2 of the normal full-term neonates was (62+/-2)%. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIRS, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.</p>

Toll-like receptor 4/nuclear factor-kappa B signaling detected in brain after early subarachnoid hemorrhage / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Inflammation and immunity play a vital role in the pathogenesis of early brain injury after subarachnoid hemorrhage (SAH). Nuclear factor-kappa B (NF-kappaB) regulates many genes essential for inflammation and immunity and is activated by toll-like receptor (TLR). This study aimed to detect the expression of the toll-like receptor 4/nuclear factor-kappa B (TLR4/NF-kappaB) signaling in the rat brain after early SAH.</p><p><b>METHODS</b>The rats were decapitated and their brains were removed at 0, 2, 4, 6, 12, 24 and 48 hours after a single injection of blood into the prechiasmatic cistern. mRNA expression of TLR4 was measured by Taqman real-time RT-PCR, and protein expression by immunohistochemistry and Western blotting. NF-kappaB activity and concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>TaqMan real-time RT-PCR and Western blotting identified a biphasic change in TLR4 expression in both mRNA and protein: an initial peak (2 - 6 hours) and a sustained elevation (12 - 48 hours). Immunohistochemical staining showed the inducible expression of TLR4-like immunoreactions predominantly in glial cells and vascular endothelium. A similar biphasic change in the activation of NF-kappaB subunit p65 as well as the production of NF-kappaB-regulated proinflammatory cytokines (TNF-alpha, IL-1beta and IL-6) were detected by ELISA.</p><p><b>CONCLUSIONS</b>These data suggest that experimental SAH induces significant up-regulation of TLR4 expression and the NF-kappaB signaling in early brain injury. Activation of the TLR4/NF-kappaB signaling may regulate the inflammatory responses after SAH.</p>

Effect of Cleaning Intestinal Tract on Jaundice in Premature Infant / 实用儿科临床杂志

Objective To study the effect of cleaning intestinal tract on treatment jaundice in premature infants.Methods We randomly assigned 48 premature infants from January to December in 2004.In the treatment group the intestinal tract was cleaned with 30～40 mL NS once daily and 3～4 days.The through cutis bilirubin(TCB),the times of blue light,me conium exhustion and feeding toleration were recorded.Results 1.The TCB was obviously descented about 34.2 ?mol/L and the time of blue light was shortened by 20 h in treated group(P

Epidermal growth factor prevents bacterial translocation in rats with acute pancreatitis / 第二军医大学学报

Objective: To evaluate the protective effect of epidermal growth factor (EGF) on intestinal barrier functionin rats with acute pancreatitis. Methods: Thirty-two male SD rats received injection of sodium taurocholate solution(3. 5 mg?L-1) into the pancreatic duct were randomly divided into control group (n=16) and treatment group (n=16). Animals incontrol group received total parenteral nutrition (TPN), animals in treatment group were fed on the same TPN formula ascontrol group and injections of EGF at a dose of 0. 2 mg' kg l' day--'. Rats were sacrificed on d 1 and d 5 of TPN. Concen-tration of xylose and fluorescein isothiocyanate (FITC)-dextran in superior mesenteric vein (SMV), protein and DNA contentin je junal mucosa were determined. Samples from SMV, mesenteric lymph nodes, pancreas, liver, spleen were harvested forcultures. Results: FITC-dextran concentration in treatment group was significantly lower than in control group [(3. 4?0. 7)vs (7. 5?0. 9) mg. L-1, P＜0. 0l]. Protein and DNA content in je junal mucosa in treatment group were significantly higherthan in control group [(2. 65?0. 23) vs (1. 12?0. 18) mg? cm-1, (0. 25?0. 07) vs (0. 12?0. 04) mg?cm-1, P