ABSTRACT
【Objective】 To investigate the value of three hemolysis tests and carboxyhemoglobin (COHb) level in the diagnosis of hemolytic disease of the fetus and newborn (HDFN). 【Methods】 From January 1, 2019 to December 31, 2022, the neonates hospitalized in the Department of Neonatology of Hebei Provincial Children's Hospital with suspected hemolytic disease who had serological testing were retrospectively enrolled in the study. They were distributed into HDFN group and non-HDFN group according to the final diagnosis. Their clinical and laboratory data were collected and analyzed, and the COHb level was detected by blood gas analyzer. 【Results】 A total of 378 neonates with HDFN and 217 neonates without HDFN were included in the study. Most of the neonates in HDFN group were full-term infants (348/378, 92.1%), with median gestational age of 39.1 (38.3, 40.0) weeks. Three hundred and fifty-four cases (354/378, 93.7%) were ABO-HDFN and the rest were Rh HDFN. There were significant differences in the level of serum total bilirubin, hemoglobin, COHb and reticulocyte percentage at admission between the two groups(P<0.05). The positive rate of three hemolysis tests in HDFN group decreased with the increase of the days after birth. The highest positive rate (more than 80%) was observed within 2 days after birth. Correlation analysis showed a negative relationship between the COHb level and the age (rs = -0.434, P<0.001) . Among the three hemolysis tests in HDFN group, the positive rate of antibody release test was the highest (69.0%), followed by the free antibody test (55.6%) and the direct antiglobulin test (DAT) (36.0%). Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value of COHb was 1.15%.The sensitivity of COHb ≥ 1.15% was 51.8%, higher than single DAT (36.0%) . The diagnosis effectiveness of three hemolysis tests couldn't be improved when combined with COHb detection(Z = -0.727, P>0.05) . 【Conclusion】 The three hemolysis tests are important in the diagnosis of HDFN, among which the antibody release test has the highest sensitivity. COHb has certain value for the diagnosis of HDFN, but joint testing cannot improve the diagnosis effectiveness of three hemolysis tests. Hemolysis tests and/or COHb detection should be conducted for neonates at risk of hemolysis as early as possible after birth.
ABSTRACT
Objective:To study the clinical features of neonatal hyperthyroidism.Methods:From September 2013 to September 2020, clinical data of neonates with hyperthyroidism admitted to the neonatal intense care unit of our hospital were retrospectively collected and analyzed.Results:A total of 7 neonates were included. The average gestation age was (35.8±2.3) weeks with 5 cases had GA<37 weeks. The median age of diagnostic was 16 d (7~18 d). The common clinical manifestations included tachycardia, irritability, low-grade fever, hyperhidrosis, bulimia, poor weight gain, diarrhea and jaundice. The levels of serum free triiodothyronine (FT 3) and thyroxine (FT 4) were elevated in all 7 cases and thyroid stimulating hormone (TSH) were decreased. The Doppler ultrasound of thyroid gland in two neonates revealed enlarged thyroid gland with abundant blood flow. All 7 mothers had hyperthyroidism with 4 mothers provided the history of hyperthyroidism and the other 3 were also confirmed after their infants were diagnosed. All 7 infants were treated with anti-thyroid drugs (ATD) and 2 were additionally given β-blockers to control heart rate. The median ATD duration was 40 d (7~58 d). 2 cases (both preterm infants) had slight decrease in FT 4 during medication. FT 4 of all 7 cases returned to normal before TSH. Conclusions:Neonatal hyperthyroidism has various and nonspecific clinical manifestations. Early diagnosis and timely treatment are important to prevent short-term and long-term adverse outcomes. Whether their mothers provide definite history of thyroid disorder or not, the thyroid function of the suspected neonates should be carefully monitored.
ABSTRACT
Objective To evaluate the clinical and radiological outcomes of skip-level anterior cervical discectomy and fusion(ACDF) for the treatment of two-level noncontiguous cervical spondylotic myelopathy(CSM).Methods There were 34 patients with two-level noncontiguous CSM underwent skip-level ACDF in our department from January 2014 to December 2016.The clinical outcome including surgery time, intraoperative blood loss,Japanese Orthopaedic Association(JOA) scores,Neck dysfunction index(NDI),the improvement rate of JOA,segment lordosis,fusion rate and Odom's criteria were evaluted.Results The surgery time was from 92 minutes to 125 minutes,mean operative time 103.28 minutes;the intraoperative blood loss was 50 to 150 mL,with average blood loss of 90 mL.The cervical spine lateral radiographs showed that the cervical physiological curvature had restored.The patients were followed up for average 6 months.The fusion rate of was 94.1％ at the lastest follow-up.No cages subside,implant failure or migration and infection occured.The JOA and NDI scores at the latest follow-up were(14.21±0.732) and (3.26±1.14),respectively,the JOA scores improvement rates was 58.62％.The segmental lordosis before surgery was(10.75±1.132)°,the one after surgery was(15.61±1.312)°,the difference was significant(P<0.05).The Odom's criteria at the lastest follow-up showed that excellent in 21 patients,good in 9 patients and fair in 4 patients,with excellent and good rate of 88.2％.Conclusion Skip-level ACDF can achieve good clinical and radiological outcomes including a high fusion rate and well maintainence of spinal curvature and intervertebral height for patients with two-level noncontiguous CSM.
ABSTRACT
Objective To investigate the effects of intervertebral bridging ossifications in patients of osteoporotic vertebral compression fracture (OVCF) on bone fracture healing.Methods A total of 170 patients of thoracolumbar vertebral endplate fracture who were admitted into our hospital were selected.Divided these patients into the observation group,namely 60 patients with nonunion of vertebral endplate after 3 months of conservative treatment,and the control group, including 110 patients with well healed vertebra after 3 months of conservative treatment.Compared the distribution of intervertebral bridging ossifications of the two groups 3 weeks after injury.Results The incidence of bridging ossification at levels of T9 to T10,T10to T11,T11to T12 in the observation group were significantly higher than that in the control group.And it showed a significantly higher incidence of bridging ossification at the second proximal intervertebral segment in the observation group than that of the control group.There was a significantly greater sagittal wedge angle in the observation group compared with the control group.Conclusion Conservative treatment may increase the risk of nonunion of osteoporotic vertebral compression fractures when there is a bridging ossification at the second proximal intervertebral level or the sagittal wedge angle was greater than 14.2°in a fresh osteoporotic vertebral compression fracture.It should be a careful choose whether to take conservative treatment or surgical intervention.
ABSTRACT
BACKGROUND:Three-dimensional visualization technique has been widely used in clinical treatment. Preoperative visualization technique al ows safe demonstration on the complex spine fracture models, and also prepare screw placement scheme according to three-dimensional model of patients. OBJECTIVE:To discuss the clinical result of treating short-segment lumbar vertebrae fracture with pedicle screw visualization. METHODS:A total of 32 patients with lumbar vertebrae fracture were treated with 182 pedicle screws. Before the screw implantation, the structure of bilateral pedicle was observed using Mimics software and the implantation parameters were measured. The operation methods and related complications were told to the patients through the reconstructed three-dimensional images. The satisfaction of the patients, operation time, and the position of pedicle screws by postoperative CT scan were assessed. The percentages of anterior vertebral height and Cobb’s angle were measured before operation, 2 weeks after operation and 8 months after operation. RESULTS AND CONCLUSION:The excellent satisfaction rate of the patients was 100%, the mean operation time was 185 minutes, and 173 pedicle screws (95.1%) were total y inserted within the pedicle. Al patients were fol owed up for 7-22 months. The results showed that the fracture healed wel . The percent of anterior vertebral height and Cobb’s angle at 2 weeks after operation were significantly decreased compared with them before operation (P0.05). Single-segment lumbar vertebrae fracture was wel treated by the pedicle screw visualization technique. This method assists to make up preoperation plan, increase the rate of patients’ satisfaction, shorten operation time, and increase the accuracy of pedicle screw insertion.
ABSTRACT
WRKY transcription factors, one of the largest families of transcriptional regulators in plants, involve in multiple life activities including plant growth and development as well as stress responses. However, little is known about the types and functions of WRKY transcription factors in Catharanthus roseus, an important medicinal plant. In this study, we identified 47 CrWRKY transcriptional factors from 26 009 proteins in Catharanthus roseus, and classified them into three distinct groups (G1, G2 and G3) according to the structure of WRKY domain and evolution of the protein family. The expression profiling showed that these CrWRKY genes expressed in a tissue/organ specific manner. The 47 CrWRKY genes were clustered into three types of expression patterns. The first type includes the CrWRKYs highly expressed in flowers and the protoplast treated with methy jasmonate (MeJA) or yeast extraction (YE). The second type contains the CrWRKYs highly expressed in stem and hairy root. The third type represents the CrWRKYs highly expressed in root, stem, leaf, seedling and the hairy root treated by MeJA. Real time quantitative PCR was employed to further identify the expression patterns of the 16 selected CrWRKY genes in various organs, the MeJA-treated protoplasts and hairy roots of Catharanthus roseus, and similar results were obtained. Notably, the expresion of more than 1/3 CrWRKY genes were regulated by MeJA or YE, indicating that these CrWRKYs are likely involed in the signalling webs which modulate the biosynthesis of terpenoid indole alkaloid and plant responses to various stresses. The present results provide a framework for functional identification of the CrWRKYs and understanding of the regulation network of terpenoid indole alkaloid biosynthesis in Catharanthus roseus.