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Objective:To investigate the effects of 4-hydroxy-2, 2, 6, 6-tetramethylpiperidine (Tempol) on the expressions of hypoxia inducible factor-1 α (HIF-1α)/vascular endothelial growth factor (VEGF) and lung development in premature neonatal rats under intermittent hypoxia (achieved by supplying a low concentration of oxygen).Methods:The intermittent hypoxia model was established.Caesarean section of rats was performed at 21 days of gestation when the fetal rats were estimated to be in labor.A total of 192 premature neonatal rats survived and were randomly divided into 6 groups according to random number table method: air control+ saline group, air control+ Tempol group, constant oxygen + saline group, constant oxygen + Tempol group, intermittent hypoxia + saline group, and intermittent hypoxia + Tempol group, 32 rats in each group.On the 7 th, 14 th and 21 st day of birth, the lung tissues of 8 neonatal preterm rats in each group were taken.Malondialdehyde (MDA) and total antioxidant capacity (TAOC) were detected by chemical analysis.The mRNA and protein levels of HIF-1α and VEGF were detected by real-time fluorescence quantitative PCR (qPCR) and immunohistochemistry, respectively.Another 8 neonatal rats in each group were taken for pulmonary function test on the 21 st day after birth. One- way ANOVA and SNK- q test were used for comparison among and between groups, respectively. Results:Compared with the constant oxygen + saline group, the intermittent hypoxia + saline group showed mild pulmonary septal thickening, increased MDA, decreased TAOC, elevated mRNA and protein expression levels of VEGF and HIF-1 α, and decreased lung function indexes.The differences were statistically significant (all P<0.05). Compared with the corresponding saline group, the intermittent hypoxia + Tempol group had decreased MDA and increased TAOC, and the differences were statistically significant at 14 d[MDA(3.09±0.45) nmol/(mg·pr) vs.4.02±0.30) nmol/(mg·pr), TAOC(3.13±0.31) U/(mg·pr) vs.(2.44±0.22) U/(mg·pr)]and 21 d[MDA(2.87±0.43) nmol/(mg·pr) vs.(4.47±0.56) nmol/(mg·pr), TAOC(3.47±0.35) U/(mg·pr) vs.(2.31±0.32) U/(mg·pr)] (all P<0.05). Compared with the corresponding saline group, the mRNA and protein expression of HIF-1 α and VEGF decreased in the intermittent hypoxia+ Tempol group, and the decrease in the mRNA expression of HIF-1 α was statistically significant at 14 d (2.11±0.60 vs.2.88±0.59) (all P<0.05). Lung function indexes, including tidal volume[(0.41 ± 0.01) mL vs.(0.36±0.02) mL], minute respiratory ventilation[(35.48 ± 2.95) mL vs.(30.62±2.27) mL], maximum expiratory flow[(2.19 ± 0.19) mL/s vs.(1.51±0.19) mL/s]and dynamic lung compliance[(2.65 ± 0.40) mL/cmH 2O vs.(1.83±0.34) mL/cmH 2O, 1 cmH 2O=0.098 kPa]increased (all P<0.05). Conclusions:Tempol can alleviate the lung injury induced by intermittent hypoxia under the intervention of a low concentration of oxygen to premature newborn rats and improve their lung function.
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Objective:To explore the cause and treatment of chylothorax after surgery for congenital heart disease(CHD) in newborns.Methods:A retrospective analysis was made to the clinical data of 49 newborns with chylothorax after surgery for CHD within the period from January 2009 to December 2019. These newborns were aged from from 1 day to 28 days with the weight from 2.0 kg to 4.1 kg. The complete transposition of great arteries was performed in 13 cases, coarctation of the aorta/ interruption of the aortic arch in 13 case, right ventricular outflow tract reconstruction/ Blalock-Taussing shunt in 9 cases, total anomalous pulmonary venous connection in 8 cases, ventricular septal defect repair and atrial septal defect repair in 4 cases, ligation of patent ductus arteriosus in 1 case and persisten truncus arteriosus in 1 case. Chylothorax occurred in the right in 19 cases, left side in 20 cases, bilateral in 9 cases and the pericardium in 1 case. The diagnosis was made at the time from 1 day to 22 days after the surgery with an average of 8 days.Results:43 patients were cured(87.75%), 41 cases(83.67%) were cured with diet and support therapy, the course lasted from 4 days to 65 days with an average of 11 days; 1 cases, because of the poor effect of diet and support therapy, was given pleural injection of high-sugar combined with octreotide treatment; 1 case received thoracic duct ligation as the conservative therapy was ineffective; 6 cases of death due to heart failure/ severe pulmonary hypertension after operation, and parents gave up.Conclusion:Individualization conservative therapy is the first choice for chylothorax, while timely surgery can raise the survival rate and save the hospitalization time and the cost.
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Objective: To identify the factors influencing brain injury in infants with congenital heartdisease (CHD) after cardiac surgery. Methods: This retrospective study investigated 103infants with CHD undergoing cardiac surgery between January 2013 and February 2016.Pre- and postoperative amplitude-integrated electroencephalography (aEEG) recordingswere assessed for background pattern, sleep-wake cycle pattern and seizure activity.Logistic regression model was used to determine the influencing factors of brain injury.Results: Pre-operatively, most infants in our study exhibited a normal background pattern,with 16.5% showing discontinuous normal voltage, whereas this pattern was observed inonly 7.8% of infants postoperatively. The improvement in background pattern after surgerywas significant (P<0.05) in infants at no more than 39 weeks of gestational age. Infants withpostoperative sepsis or severe postoperative infection were prone to show a worse sleep-wake cycle pattern after heart surgery. Conclusion: The improvement in brain function ofinfants with CHD after cardiac surgery was associated with the gestational age andpostoperative infection
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Objective:To investigate the safety of inter-hospital referral and the prognosis of neonatal with critical congenital heart disease.Methods:The criticality score, transit distance and time, and the prognosis of 237 newborns with critical congenital heart disease in Guangdong Provincial People′s Hospital from July 2016 to July 2018 were retrospectively analyzed.Results:A total of 237 children were included (162 male and 75 female) with the median age of 6 days and the median body weight of 2.98 kg.The median transit distance was 90 km.The average value of neonatal critical illness score (NCIS) was (86.54±9.05) scores before transport; 136 cases were greater than 90 scores, 84 cases between 70 and 90 scores, 17 cases less than 70 scores; while the average NCIS was (87.05±8.19) scores when arrived at neonatal intensive care unit (NICU), 138 cases were greater than 90 scores, 82 cases between 70 and 90 scores, 17 cases less than 70 scores.There were no significant differences in the scores of critical cases before and after transfer according to the transfer time and distance ( t=0.346, P>0.05). There was no one death occurred during the transfer process.All over, 222 cases were cured and discharged from the hospital after surgery and or medical interventional treatments, 15 cases died after giving up treatment or losing the opportunity for surgery. Conclusions:It is safe and effective of the inter-hospital transport for the rescue of infants with critical congenital heart disease when followed the principles and transport rules and regulations, with trained workers and special equipments.
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Objective@#To analyze the neurodevelopmental outcome and its risk factors in infants with CHD at 18 months of age.@*Methods@#Eighteen-month-old infants with CHD at the follow-up clinic of our hospital were selected. The Bayley scales of infant development(BSID) were used to evaluate the levels of mental development(MDI) and psychomotor development(PDI). The clinical features during hospitalization were reviewed, and the risk factors of MDI and PDI were analyzed.@*Results@#A total of 116 children with CHD underwent BSID evaluation at 18 months of age. Both the MDI(95.38±22.98) and PDI(87.84±22.57) of the cohort were significantly lower than the average value of the normal population(P<0.05). In infants with cyanotic CHD, the MDI was higher(β=17.218). The longer the length was of the hospital stay, the lower the PDI(β=-0.577). In patients undergoing cardiopulmonary bypass surgery, the PDI was higher(β=11.956). Compared to infants with relatively normal behavior, the PDI of infants with mild behavioral problems was lower(β=-10.605).@*Conclusion@#Children with CHD who underwent cardiac surgery have delayed neurodevelopmental outcomes compared with those of healthy children. The outcomes of infants with cyanotic CHD or undergoing cardiopulmonary bypass surgery was better than others. Long hospital stays and mild behavioral problems were risk factors for poor neurodevelopmental outcomes.
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Objective To analyze the neurodevelopmental outcome and its risk factors in infants with CHD at 18 months of age. Methods Eighteen-month-old infants with CHD at the follow-up clinic of our hospital were selected. The Bayley scales of infant development( BSID) were used to evaluate the levels of mental development( MDI) and psychomotor develop-ment( PDI) . The clinical features during hospitalization were reviewed, and the risk factors of MDI and PDI were analyzed. Results A total of 116 children with CHD underwent BSID evaluation at 18 months of age. Both the MDI(95. 38 ± 22. 98) and PDI(87.84 ±22.57) of the cohort were significantly lower than the average value of the normal population(P<0.05). In infants with cyanotic CHD, the MDI was higher(β=17. 218). The longer the length was of the hospital stay, the lower the PDI (β= -0. 577). In patients undergoing cardiopulmonary bypass surgery, the PDI was higher(β=11. 956). Compared to in-fants with relatively normal behavior, the PDI of infants with mild behavioral problems was lower(β=-10. 605). Conclusion Children with CHD who underwent cardiac surgery have delayed neurodevelopmental outcomes compared with those of healthy children. The outcomes of infants with cyanotic CHD or undergoing cardiopulmonary bypass surgery was better than others. Long hospital stays and mild behavioral problems were risk factors for poor neurodevelopmental outcomes.
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Objectlve To explore the correlation between amplitude-integrated electroencephalographic(aEEG) findings and clinical features and to investigate the status of perioperative brain function in infants with critical congenital heart disease (CCHD) and its influencing factors.Methods Newborns and infants with critical CHD who were admitted to the NICU at our hospital were included.Postoperative aEEG was continuously monitored and analyzed,and its correlation with clinical conditions was compared.Results A total of 226 patients were enrolled.Of the 226 patients who underwent postoperative aEEG monitoring,approximately 5.8％ showed mild abnormal background patterns,0.9％ showed severe abnormalities,27.4％ demonstrated an immature SWC,and 3.5％ lacked SWC.The patients who had a history of hypoxia at birth exhibited delayed sternal closure or showed severe postoperative neurological symptoms and had higher probabilities of postoperative SWC abnormalities.Several infants,all with complex CHD,had postoperative seizures.Conclusion Gestational age and oxygen deficiency at birth were the risk factors of brain injury.Delayed sternal closure,severe postoperative infection,and postoperative neurological symptoms were risk factors for postoperative brain injury.Postoperative nervous system monitoring and prevention postoperative severe infection may obviously improve the brain function of neonates and small infants with critical congenital heart disease.
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Objective To investigate the correlation between the indications,findings,interventions of fibrobronchoscopy(FB) in neonates and their correlative diseases with neonatal FB results and clinical data.Methods Retrospective case series of 243 consecutive patients of 28 days old or younger were investigated underwent FB for the first time from January 2010 to December 2014,at a tertiary care hospital.The common indications for FB and detection rate of respiratory tract diseases were collected.If the findings of FB had significant associations with premature birth and other diseases were analyzed.Associations between interventions and basic illnesses were also analyzed.Results Of the 243 patients undergoing 275 procedures of FB,201 cases were boys(73.1％).The age of FB was (13.34 ± 9.76) days and the weight was (3.08 ± 0.68) kg.Forty-five cases were premature infants (16.4％).A total of 254 procedures were found to have congenital diseases (92.4％),and 177 cases of them had congenital heart diseases (CHD) (64.4％).Common indications for FB were dyspnea(140 cases,50.9％),tachypnea(82 cases,29.8％),and stridor(71 cases,25.8％).A total of 188 upper airway lesions were found and the most common findings were laryngomalacia(56 cases,20.4％) and vocal cord paralysis(bilateral/unilateral,50 cases,18.2％).A total of 315 lower airway lesions were found and the most common findings were airway mucosal inflammation (98 cases,35.6％),trachea and main bronchial stenosis (73 cases,26.5 ％).A total of 21 cases (7.6％) underwent supraglottoplasty during or after FB,while 17 cases (6.2％) underwent tracheal dilation and 10 cases (3.6％) underwent tracheotomy.Compared with non-CHD neonates,neonates with CHD were statistically significantly less likely to have congenital lesions statistically,such as laryngomalacia(15.8％ vs.28.6％,P =0.012),bilateral vocal cord lesions(6.2％ vs.21.4％,P =0.000) and congenital laryngeal dysplasia(0 vs.7.1％,P =0.001).The tracheotomy(0 vs.10.2％,P =0.000) and supraglottoplasty(2.3％ vs.17.3％,P =0.000) were more rare.Nevertheless,they were more likely to have secondary lesions such as the left main bronchial stenosis caused by extrinsic compression (23.7％ vs.1.0％,P =0.000),abnormal bronchial anatomy(9.6％ vs.2.0％,P =0.018),left vocal cord paralysis(9.0％ vs.1.0％,P =0.008) and airway mucosal inflammation(41.8％ vs.24.5％,P =0.004).The tracheostenosis and main broncial stenosis (37.3％ vs.7.1％,P =0.000) with long-term intubation(78.5％ vs.58.2％,P =0.000) were more common.There was no significant difference between term neonates and premature infants in the detection rate of respiratory tract diseases (P ＞ 0.05),tracheotomy (0 vs.4.3 ％,P =0.322),supraglottoplasty (13.3 ％ vs.6.5 ％,P =0.205) or long-term i ntubation (80.0％ vs.69.6％,P =0.157).Complications caused by procedure were rare and mild.Conclusions FB can detect whether the neonates with dyspnea,tachypnea and stridor have laryngomalacia,vocal cord paralysis,airway mucous edema,tracheal and main bronchial stenosis and other signs,and FB may play an important role in diagnosis,treatment and prognosis evaluation of neonatal respiratory diseases.
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Objective To determine the long term outcomes of laryngomalacia infants with anomalies and to determine the clinical practice guideline for these infants.Methods The charts of infants with moderate to severe laryngomalacia,who were admitted to our hospital between January 2013 and December 2015,were retrospectively reviewed.These infants were divided into two groups,anomaly(A) group(n=37) and non-anomaly (NA) group(n=19).Results Fifty-six cases were enrolled.Infants in A group were older at symptom relief than those in NA group[(10.00±3.56) months vs.(7.89±3.03) months,P＜0.05],and the weight percentiles of infants in A group were lower at 3,6 and 12 months than those in NA group(P＜0.05).There was no statistically significant difference between the two groups on the weights percentiles in infants at 24 months after diagnosis.Five of 37 cases in A group and 3 of 19 cases in NA group had supraglottoplasty.One infant in A group had tracheotomy.Conclusion Both breathing difficulty and development retardations of infants with moderate or severe laryngomalacia could gradually improved with age.There is not enough evidence to support the aggressive supraglottoplasty for infants with anomalies and laryngomalacia.
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Objective To determine the effectiveness of systolic blood pressure gradient between the right arm and the right leg(SBPG) tests in the diagnosis of neonatal aorta anomaly(AoA).Methods The SBPG of infants suspected of having critical congenital heart diseases were collected prospectively,who were admitted to Guangdong General Hospital from January 2013 to December 2015.The results of SBPG test were compared with those of echocardiography or cardiac computed tomography (golden standard).The rates of true positive,true negative,false positive,false negative were calculated under cutoff values of 5 mmHg(1 mmHg =0.133 kPa),10 mmHg,15 mmHg and 20 mmHg,respectively.Receiver operating characteristic (ROC) curves was used to compare tests of different cutoff and the areas under the ROC curve were also calculated.Results Among 664 enrolled infants,67 cases were confirmed by golden standard test.The systolic blood pressure in the right arm,the legs and SBPG in AoA group and non-AoA group were (88.0±20.4) mmHgvs.(73.4±9.3) mmHg (P＜0.01),(66.1 ±10.1) mmHg vs.(69.0 ±9.7) mmHg(P＞0.05) and (22.6±17.8) mmHgvs.(2.3 ±4.8) mmHg(P ＜0.01),respectively.In these patients,31 cases(46.3％),31 cases(46.3％),27 cases(40.3％) and 21 cases(31.3％) were diagnosed of AoA,and 36 cases(53.7％),36 cases (53.7％),40 cases(59.7％),and 46 cases (68.7％) were missed by SBPG tests of 5 mmHg,10 mmHg,15 mmHg and 20 mmHg,respectively (P ＜ 0.01).The rates of true negative among those groups were 94.1％,99.5％,99.7％ and 100.0％,and the areas under ROC curve were 0.656,0.722,0.695 and 0.657,respectively (P ＜ 0.01).Conclusions Almost half of AoA infants could be screened out by SBPG test.The cutoff of 10 mmHg could probably be used to screen potential AoA infants,with higher true positive rate and lower false positive rate.
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Cardiovascular assessment and monitoring in pediatric intensive care unit and neonatal intensive care unit requires careful integration of physical findings,laboratory studies and hemodynamic data like cardiac output measured using invasive and vasive methods.Which is useful for the clinician to understand the patient′s overall condi-tion,discern the patient′s trajectory,and anticipate associated consequences of current management choices.
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Bronchopulmonary dysplasia (BPD)characterized as the abnormal development of premature lung and trachea influenced by perinatal factors is the most common respiratory disease in very premature infants,and is also one of the diseases confirmedly related to poor quality of life.With the advancement of neonatal research and the im-provement in clinical care,more very premature infants with BPD survived to discharge.BPD is becoming the disease which both neonatologists and pediatricians should pay much attention to.The definition of BPD in recent years is in controversy.In this paper,the physiologic definition of BPD was comprehensively reviewed as a recently more accepted definition.
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Objective To explore the effects of delivery classification scale for fetal cardiac disease on the prenatal and postnatal integrated treatment strategies.Methods Delivery classification scale for fetal cardiac disease included:grade Ⅰ,no hemodynamics instability; grade Ⅱ,ducted-dependent lesions,stable hemodynamics anticipated;grade Ⅲ,possibility or likelihood of hemodynamic instability; IMPACT(delivery immediately heart intervention) level,hemodynamic instability is anticipated at separation from placental circulation.During August 2006 to May 2010,a retrospective study of 46 cases of prenatal diagnosis of congenital heart disease and delivery in one cardiac center was taken,in which 33 in grade Ⅰ,9 in grade Ⅱ,4 in grade Ⅲ,and no IMPACT.Results Thirty-nine boys and 7 girls were born at (38.0 ± 1.4) weeks of gestation and had consistent fetal diagnoses of mainly cardiac abnormalities with postnatal screen.Thirteen neonates underwent cardiac intervention within one week after birth with one death,including 2 in grade Ⅰ,7 in grade Ⅱ,4 in grade Ⅲ,of them 1 death.Seven infants including 5 in grade Ⅰ and 2 in grade Ⅱ underwent cardiac intervention with one death.The remaining 26 children in grade Ⅰ had uneventfully outcomes,in which 7 cases of surgical operation,17 cases of interventional therapy,2 cases of spontaneous healing.Conclusion Delivery classification scale for fetal cardiac disease should have some guiding significance for early treatment strategies and could enhance closely integration of prenatal diagnosis and postnatal treatment.The most fetuses in grade Ⅰ need not undergo cardiac interventions in neonatal stage.However,early cardiac intervention for fetuses in grade Ⅱ and Ⅲ should be carried out postnatally with the help of neonatologists.
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Objective To investigate the clinical characteristics,distribution and drug sensitivity of pathogens causing intravenous catheter-related bloodstream infections (CRBSIs) in pediatric intensive care unit (PICU) so as to use antibiotics reasonably.Methods All patients with CRBSIs in PICU of Guangdong General Hospital from September 2009 to September 2014 were investigated and the drug resistance profiles of pathogens causing CRBSIs were also analyzed retrospectively.Results Between 2009 and 2014,there were totally 10 834 catheter days and 23 episodes of CRBSIs with an incidence of 2.1 infections per 1 000 catheter days.Catheter indwell time ＜ 7 days in 9 cases (39.1％),8 to 14 days in 10 cases (43.5％),14 to 21 days in 4 cases (17.4％).There were 13 strains (56.6％) of gram-positive bacteria,5 strains (21.7％) of gram-negative bacteria and 5 strains (21.7％) of fungi.The main pathogens causing CRBSIs were coagulase negative Staphylococci (7 strains,30.4％),Staphylococcus aureus (3 strains,13.0％),Candida albicans(3 strains,13.0％),Candida parapsilosis(2 strains,8.7％),and Enterobacter cloacae (2 strains,8.7 ％).The susceptibility to Vancomycin,Linezolid and Teicoplanin of coagulase negative Staphylococ cus such as S.epidermidis and to Imipenem,Piperacillin/Tazobactam,Cefoperazone/ Sulbactam and Amikacin of gram-positive bacteria arrived at 100.0％,respectively.The candida were 100％ susceptible to Amphotericin B,5-Flucytosine,Fluconazole and Voriconazole.Twenty-one cases (91.3％) received antibiotic treatment versus no antibiotic in 2 cases (8.7％).The average number of antibiotic kinds administered on the patients with fungal infection was 4.4,bacteria were 1.4.Ten cases (43.5％) treatment with 1 kind of antibiotic,4 cases (17.4％) with 2,4 cases (17.4％) with 3,5 cases (21.7％) with more than 3.Twenty-two cases (95.7％) cured and 1 case died (4.3％).Conclusions The major species of pathogen causing CRBSIs was coagulase negative staphylococci in PICU.It is critical for clinicians to guard against fungal infection because of prolonged catheter indwelling time and more antibiotics administered before indwelling catheter.It is effective way to prevent the CRBSIs by reasonably using antibiotics and shortening the time of catheter indwelling.Monitoring CRBSIs pathogenic bacteria distribution and drug susceptibility helps reasonable administration of antibiotics in the earlier time.
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Objective To investigate the time for spontaneous closure of the ductus arteriosus and the trends of cardiac index(CI),peripheral vascular resistance index(SVRI)and blood pressure of neonates with different gesta-tional ages(GA). Methods A prospective observational study about 95 newborns,including 20 full - term and 75 pre-term infants were divided into 4 groups according to their GA as GA ﹤ 32 weeks(n = 27),32 weeks≤GA ﹤ 34 weeks (n = 25),34 weeks≤GA ﹤ 37 weeks(n = 23),GA≥37 weeks(n = 20). Patent ductus arteriosus was diagnosed by echocardiography(ECHO)at the time of 24 h,48 h,72 h,7 d and 14 d. CI,SVRI and blood pressure were measured with ultrasonic cardiac output monitor(USCOM). Results The cumulative spontaneous closure rate of arterious ductus of 32 weeks≤GA ﹤34 weeks,34 weeks≤GA ﹤37 weeks group and GA≥37 weeks group at 24 h after birth was 44. 0% , 61. 0% and 90. 0% respectively. However the rate was only 59. 1% at 72 h with the GA less than 32 weeks,of which 9 cases needed ibuprofen and 1 patient was conducted ductus arteriosus ligation. The differences in cumulative closure rate among 4 groups based on GA at 5 time points were statistically significant(χ2 =6. 756,4. 735,18. 890,11. 366,28. 159,all P ﹤0. 05). There was significant increase of systolic blood pressure,diastolic blood pressure and SVRI with ductus arte-riosus closure(t = -32. 561,-19. 913,-31. 791,4. 760,all P ﹤0. 000 1;t = - 25. 091,- 23. 400,- 21. 147,2. 240,all P ﹤0. 05;t = -10. 931,-9. 975,-9. 629,2. 350,all P ﹤ 0. 05). Whereas CI significantly decreased in groups of GA ﹤32 weeks,32 weeks ≤GA ﹤34 weeks,34 weeks ≤GA ﹤37 weeks(t =9. 224,6. 515,5. 996,all P ﹤ 0. 001)and no sig-nificant changes in GA≥37 weeks(t =0. 940,P ﹥0. 05). Conclusions With the increase of gestational age,the rate of naturally early arterial catheter closure is higher. Whereas there still are nearly one - third infants requiring medical or surgical intervention in the group of GA ﹤32 weeks. Ductus arteriosus has great influence on hemodynamics. For preterm, especially very low birth weight preterm,the use of ECHO and USCOM can early detect and treat patent ductus arteriosus.
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[ ABSTRACT] AIM:To investigate the biological characteristics of newborn rabbit tracheal chondrocytes in vitro. METHODS:Newborn rabbit tracheal chondrocytes were obtained by the method of enzyme digestion, and then cultured in monolayer in vitro.Morphological and growth observations were performed under inverted phase contrast microscope.The ultrastructures of the cells were observed under scanning electron microscope and transmission electron microscope.The bi-ological characteristics of secreted extracellular matrix components were detected by real-time PCR, immunocytochemistry staining and toluidine blue staining.RESULTS: Newborn rabbit tracheal chondrocytes isolated and cultured in vitro showed short triangular or irregular shapes, and adherent growth very well.The ultrastructures of the cells showed pore and abundant cytoplasm and organelles, with a lot of protein secretions in the cells.The chondrocytes expressed the mRNA of collagen I, collagen II and proteoglycans, mainly collagen II and proteoglycans.Immunocytochemistry staining showed col-lagen II and SOX9 positive, and collagen I weakly positive.Toluidine blue staining was also positive.CONCLUSION:Enzyme digestion and monolayer culture are suitable method to obtain newborn rabbit tracheal chondrocytes.These cells, secreting extracellular matrix components, are able to be selected as seed cells for tissue engineering of trachea in vitro, and used to study the therapeutic method for neonatal rabbit tracheal stenosis.
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Cardiac dysfunction in preterm infants is a common acute and critical illness,associated with higher mortality,and can cause severe short-term and long-term sequelae. Therefore,understanding the main fea-ture of hemodynamics in premature neonates,and the accurate and appropriate clinical monitoring methods are essential to assess cardiac function in early time. This review summarizes the main hemodynamic problem and cardiac function assessment methods in preterm neonates.
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Objective The aim of this study is to retrospectively analyze perioperative managements of very-low-birth-weight(VLBW) preterms with hemodynamic significant patent ductus arteriosus (hsPDA).Methods Between January 2006 and December 2011,totally 22 VLBW preterms with hsPDA underwent surgical ductal ligation.There were 12 boys and 10 girls.The median gestatianal age was 29 weeks (24 + 5-32 +6 weeks).The birth weight was (1103 ± 228) g(640-1440 g).The Apgar score was 6.1 ± 2.2 at 1 minute,8.6 ± 1.2 at 5 minutes.The average ductal size was (3.79 ± 1.01)mm (2.0-5.9 mm)、(2.69 ± 0.84) mm/kg(1.23-4.23 mm/kg),left atrial diameter to aortic root ratio(LA:AO) was 1.69 ± 0.41.The median weight at surgery was 1500 g(640-2100 g),average (1512 ±539) g.The median age at surgery was 24 days (11-167 days).Results 1 case death because of anesthetic accident.The average hospitalization days were (67.1 ± 36.1) days.The days of ventilation treatment after surgery were 2-44 days,15 cases (68.2％) weaned from mechanical ventilation within seven days after surgeries.The complications includes pulmonary hemorrhage (18.2％),necrotizing enterocolitis (13.6％),septicemia(22.7％),broncho-pulmonary dysplasia (63.7％),brain injury(18.1％),retinopathy of prematurity (31.8％),pneumonia (86.4％) and metabolic acidosis (45.5 ％).Conclusion For VLBW preterms with hsPDA,early diagnosis and early interfere are key points.Surgical PDA ligation is a promising option to avoid severe complications when medical treatments are ineffective.
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Flexible bronchoscopy has become an important diagnostic and therapeutic technique in the neonatal intensive care unit.With the improvement of the instrument and operating techniques of the bronchoscopists,flexible bronchoscopy has been applied in the preterm infant that weighted 600 grams.In this article,a review of application of flexible bronchoscopy in neonates,including diagnostic and therapeutic indications,security in the neonatal applications would be presented.
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BACKGROUND: Bone marrow mesenchymal stem cells are important seeded cells for construction of tissue-engineered trachea, but there is no special surface marker. Therefore, identification of bone marrow mesenchymal stem cells is mostly based on morphology, phenotype antigen and the function of differentiation. OBJECTIVE: To explore the feasibility of the tracheal chondrogenic differentiation of bone marrow mesenchymal stem cells under a special condition through isolation, cultivation and identification of bone marrow mesenchymal stem cells. METHODS: Rabbit bone marrow was acquired in the sterile environment to isolate and culture bone marrow mesenchymal stem cells to passage 2 by bone marrow adherence and screening method. Flow cytometry identified the phenotype CD44, CD45 of bone marrow mesenchymal stem cells at passages 1 and 2. Rabbit tracheal samples were acquired in the sterile environment, the tracheal chondrocytes were isolated and cultured by enzyme digestion, and toluidine blue staining was used to detect aggrecan. Bone marrow mesenchymal stem cells were co-cultured with tracheal chondrocytes by Transwel and transforming growth factor β1. Cel morphology was detected under an inverted microscope. Real-time quantitative PCR and toluidine blue staining detected the extracel ular matrix components, such as type Ⅱ col agen and aggrecan.RESULTS AND CONCLUSION: After isolation and culture, cells were spindle and irregular in morphology, and passaged cells thrived that were gathered into a fish-like colony growth. For passage 1 bone marrow mesenchymal stem cells, the positive rates of phenotype antigen CD44 and CD45 were respectively 96.97% and 13.72%; for passage 2 cells, the positive rates of phenotype antigen CD44 and CD45 were 99.11% and 8.54%, respectively. Tracheal chondrocytes were positive for toluidine blue staining. The morphology of induced bone marrow mesenchymal stem cells changed from long fusiform to triangular or irregular shape, indicating the chondrocytes expressed type Ⅱ col agen and aggrecan, and toluidine blue staining was positive. These results showed bone marrow adherence and screening method could acquire bone marrow mesenchymal stem cells, and the purity of passage 2 cells is higher. Under a special condition, bone marrow mesenchymal stem cells have the potential of chondrogenic differentiation, and can be selected as seed cells for construction of tissue-engineered trachea.