Value of short-time transcutaneous carbon dioxide and oxygen pressure monitoring in critically ill preterm infants / 中华围产医学杂志

Objective:To investigate the value of short-time transcutaneous carbon dioxide pressure (TcPCO 2) and transcutaneous oxygen pressure (TcPO 2) monitoring in critically ill preterm infants. Methods:From January to December 2018, 62 critically ill neonates receiving respiratory support at Guangzhou Women and Children's Medical Center were retrospectively enrolled. A total of 348 sets of paired data including TcPCO 2/TcPO 2 and arterial carbon dioxide pressure (PaCO 2)/arterial oxygen partial pressure (PaO 2) were analyzed. The patients were divided into different groups based upon birth weight (23 cases>1 000 g-≤1 500 g, 129 sets of paired data; 18 cases≤1 000 g, 130 sets of paired data) and gestational age (16 cases born at ≤28 gestational weeks, 127 sets of paired data; 29 cases born at 28-34 gestational weeks, 159 sets of paired data) and the differences between groups were compared. The correlation and consistency of TcPCO 2/TcPO 2 and PaCO 2/PaO 2 were evaluated using Pearson's correlation and Blan-Altman scatter plots. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of TcPCO 2 in neonates with hypercapnia. Results:There was a positive correlation between TcPCO 2 and PaCO 2 in all patients ( r=0.913, 95% CI:0.894-0.929, P<0.05). In patients whose birth weight was>1 000 g-≤1 500 g or≤1 000 g, TcPCO 2 and PaCO 2 were positively correlated and the consistency were good ( r=0.909, 95% CI:0.874-0.935; r=0.934, 95% CI:0.908-0.953; both P<0.05), and the same finding was also observed in patients born at≤28 gestational weeks or 28-34 weeks of gestation ( r=0.938, 95% CI:0.913-0.956; r=0.871, 95% CI: 0.827-0.904; both P<0.05). The sensitivity, specificity and area under curve of TcPCO 2 in the diagnosis of hypercapnia were 90.91%, 85.85%, and 0.942, respectively. There was a poor correlation between TcPO 2 and PaO 2 in all patients and those with birth weight >1 000 g-≤1 500 g or gestational age 28-34 weeks (all r<0.75, all P<0.05). There was no correlation between TcPO 2 and PaO 2 in the birth weight ≤1 000 g and gestational age ≤28 weeks groups (both P>0.05). Conclusions:Short-time TcPCO 2 monitoring can accurately assess PaCO 2 in critically ill neonates requiring respiratory support and is of high diagnostic value for hypercapnia. However, TcPO 2 has limitation in evaluating PaO 2 and other indicators may need to be involved.

Neonatal transaldolase deficiency: a case report / 中华围产医学杂志

We report a neonate with transaldolase deficiency caused by compound heterozygous variation of the TALDO1 gene. A pregnant woman, who had an adverse pregnancy history, was found with multiple fetal abnormalities on prenatal ultrasound and the following whole exon sequencing indicated a likely pathogenic heterozygous variation of c.462-2A>G and c.574C>T(p.R192C) in TALDO1 gene in the fetus. A body was born at 38 +1 weeks and presented dysmorphic features (cutis laxa/wrinkled skin and low-set ears, etc.), splenomegaly, anemia, abnormal liver function and coagulation. In combination with the prenatal testing results, transaldolase deficiency was diagnosed. The patients still had cutis laxa/wrinkled skin on the back of both hands and neck at one year and three months old. Therefore, for babies with hepatosplenomegaly, anemia, thrombocytopenia, coagulation dysfunction, at the same time with dysmorphic features such as cutis laxa, low-set ears, attention should be paid to the investigation of transaldolase deficiency.

Video essentials of minimally invasive McKeown esophagectomy with systematic lymph node dissection / 中国胸心血管外科临床杂志

@#（正）食管癌位于我国恶性肿瘤发病率第 5 位及死亡率第 4 位，每年大约有 10 万新增病例，占全球50% 以上。食管癌病因复杂，发病隐匿，目前公认的治疗方案是以手术为主、放化疗为辅的综合治疗。而传统开胸手术治疗创伤大，并发症多，恢复时间长，预后较差。经过多年的不断探索与发展以及腔镜技术的日益成熟，以三野清扫为目的的胸腹腔镜联合食管癌切除已成为一种趋势，其在切除范围、淋巴结清扫程度、切口疼痛程度、快速康复以及预后等方面较传统术式有明显优势，同时并发症发生率并未增加[1]。本视频旨在展示胸腹腔镜食管癌切除术的手术入路、操作要点及术后情况。

Analysis of the clinical characteristics of late-onset sepsis in very low birth weight infants / 临床儿科杂志

Objective To explore the clinical characteristics including the morbidity, clinical manifestation, and pathogens of late-onset sepsis (LOS) in very low birth weight (VLBW) infants in neonatal intensive care unit (NICU). Methods Clinical data of all VLBW infants in NICU from January 2011 to December 2013 were collected. According to the results of blood culture, the VLBW infants diagnosed with LOS were divided into confirmed LOS group and clinical LOS group. The morbidity, clinical manifestations, common pathogens, and drug sensitivity of LOS were retrospectively analyzed. Results In 226 VLBW infants, there were 117 cases of LOS with the morbidity at 51.8%. Forty-five infants were confirmed to have LOS by blood culture, accounting for 19.9% (45/226); another 72 infants were diagnosed with clinical LOS, accounting for 31.9% (72/226). The rates of tachycardia and temperature fluctuation in confirmed LOS group were higher than those in clinical LOS group, and there were significant differences (P<0.05). There were 51 strains of pathogenic bacteria, with 32 Gram-negative bacteria (62.7%), 16 Gram-positive bacteria (31.4%), and 3 fungi (5.9%).The common pathogenic bacteria were Klebsiella pneumoniae and coagulase negative Staphylococcus,the most of which were multidrug-resistant bacteria.Conclusions The incidence of LOS in VLBW infants is high. The main clinical manifestations are sudden changes in breathing, heart rate, mental state, and skin color. Although these manifestations are not specific,they could serve as early warning.The common pathogenic bacteria are Klebsiella pneumoniae and coagulase negative Staphylococcus,and both of them are multidrug resistant.

Effect and security of minimally invasive surfactant therapy in neonatal respiratory distress syndrome / 中华实用儿科临床杂志

Objective@#To explore the effect and security of minimally invasive surfactant therapy (MIST) in treatment of preterm infants with neonatal respiratory distress syndrome (NRDS).@*Methods@#A total of 48 pretrm infants with gestational ages between 30-36 weeks diagnosed with NRDS in Guangzhou Women and Children′s Medical Center from January 2017 to January 2018 were randomly divided into MIST group (23 cases) and intubation-surfactant-extubation+ continuous positive airway pressure ventilation (INSURE) group (25 cases) by adopting random number table method.The patients in MIST group were put on nasal continuous positive airway pressure (nCPAP) and a thin vascular catheter was inserted through the vocal cords under direct vision with direct laryngoscope then infused pulmonary surfactant(PS) into the lung; the patients in INSURE group were endotracheally intubated and infused with PS into the lung through endotracheal tube with positive airway pressure, then extubated and put on nCPAP again.The incidences of adverse reactions and various complications related to the 2 groups were observed.@*Results@#There were no significant differences between 2 groups in oxygen saturation decrease(26.1% vs.36.0%), bradycardia (13.0% vs.24.0%) and reuse PS (8.7% vs.4.0%) (all P>0.05). There were no significant differences between 2 groups in noninvasive ventilation time [8 d (5.5-12.5 d) vs.7 d(5.0-14.0 d)], total oxygen intake time [12 d(7.0-26.5 d) vs.10 d(10.0-23.0 d)] and length of hospital stay [(34.22±16.06) d vs.(30.88±14.35) d] (all P>0.05). There was no death or intraventricular hemorrhage in both groups, and there were no significant differences between 2 groups in the incidences of pneumothorax (0 vs.4.0%), bronchopulmonary dysplasia (21.7% vs.16.0%), retinopathy of prematurity (21.7% vs.12.0%) and necrotizing enterocolitis (21.7% vs.12.0%) (all P>0.05).@*Conclusions@#MIST technique is a safe and effective method to administrate surfactant in preterm infants with NRDS.In the NRDS patients who do not need intubation and mechanical ventilation, MIST technique can be used to administrate PS.

Late in-the-bag dislocation of IOL bag complex:Mechanisms in etiology and risk factors / 眼科新进展

Late in-the-bag dislocation of intraocular lens bag complex is a rare but potential complication after cataract surgery,which can affect the quality of patients'life seriously,and usually need surgical treatment.People are paying more attention to this complication,because it has been reported with increasing frequency in recent years.This complication may present after a long time frame.There is a research showing that the interval between cataract surgery and the dislocation was 10.9 years.The cumulative risk of IOL dislocation at 10 years,20 years,and 25 years after cataract extraction was 0.1％,0.7％,and 1.7％ respectively.Late in-the-bag IOL dislocation is a result of progressive zonular dehiscence up to many years after cataract surgery,and its genesis is multifactorial.This article reviews the incidence,possible mechanism and risk factors of late in-the-bag IOL dislocation.

A study on the relationship between neurodevelopment and early nutritional status of very low birth weight infants / 中国新生儿科杂志

Objective To study the relationship between neurodevelopment and early nutritional status of very low birth weight(VLBW)infants in NICU.Methods VLBW infants admitted to NICU of our hospital from January 2013 to December 2014 and received regular follow-up management at our high-risk infant outpatient clinic were retrospectively studied. All infantsˊdevelopmental quotient ( DQ) were evaluated at 3 months of corrected gestational age ( cGA) . DQ ≥130 was defined as excellent, 115-129 above medium, 85-114 medium, 70 -84 below medium and ≤69 abnormal. According to their DQ scores, infants were assigned into two groups, normal neurodevelopment group ( DQ≥85 ) and abnormal neurodevelopment group ( DQ<85 ) . Nutritional status during hospitalization between the two groups were compared.Results A total of 125 VLBW infants were recruited.At three months of cGA, 2 cases ( 1. 6℅) had excellent DQ score; 3 ( 2. 4℅) above medium; 63 ( 50. 4℅) medium;57 (45. 6℅) below medium. 68 cases (54. 4℅) in the normal development group and 57 (45. 6℅) in the abnormal group. The total energy intake, the proportion of enteral energy supply on 4 d, 7 d, 14 d after birth and amino acid supply on 4 d, 7 d were significantly higher in the normal neurodevelopment group than the abnormal group (P<0. 05). Comparing with the abnormal group, weight loss of VLBW infants in the normal neurodevelopment group was less; the time needed to reach birth weight and exclusive enteral nutrition in the normal neurodevelopment group was shorter. The differences were statistically significant between the two groups(P<0.05).Conclusions VLBW infantsˊearly nutritional status may influence their neurodevelopmental outcome.

Expression of Chimeric Influenza Hemagglutinin Antigen (cH7/3) using the Baculovirus Expression System and Identification of its Biological Activities / 病毒学报

Hemagglutinin (HA) contains a head domain with a high degree of variability and a relatively conserved stem region. HA is the major viral antigen on the surface of the influenza virus. To define the biologic activities of chimeric HA bearing different head domains and stem regions or their potential use, a HA chimeric gene containing the head domain of the H7 subtype virus and stem region of the H3 subtype virus was modified and expressed using a baculovirus expression vector. Then, the secreted protein was purified and its biologic activities characterized. Approximately 1.4 mg/mL cH7/3 HA could be obtained, and its molecular weight was ≈ 70 kD. The trimer form of cH7/3 protein had hemagglutination activity and could be recognized by specific antibodies. The method described here can be used for further studies on the screening of HA stem-reactive antibodies or the development of vaccines with conserved epitopes.

Application of bilevel positive airway pressure in treatment of respiratory distress syndrome in preterm infants / 吉林大学学报(医学版)

Objective To explore the influence of intubation-surfactant-extubation (InSurE)therapy combined with bilevel positive airway pressure (BiPAP)in the use time of mechanical ventilation,and to clarify the value of BiPAP in the treatment of respiratory distress syndrome in the preterm infants.Methods Toral 95 preterm infants with respiratory distress syndrome were treated with InSurE therapy during January 2011 to October 2014. Among them,the preterm infants before January 2013 were selected as control group who were treated with InSurE and nasal continuous positive airway pressure (nCPAP).After January 2013, 60 preterm infants were treated with BiPAP,as BiPAP group.The rates of InSurE failure,the need for mechanical ventilation (MV)on the 7th day after InSurE failure, total non-invasive ventilation time, total mechanical ventilation time, atmospheric oxygen therapy time and incidence of clinical complications were compared between two groups.Results ① There were no significant differences in the clinical data of the preterm infants between two groups, such as gender and age.② Although there was no significant difference in the failure rate of InSurE,but the rate of repeated mechanical ventilation during 1 week in BiPAP group was lower than that in control group (P <0.01).③ The Rank sum test result showed that the total time of non invasive ventilation in BiPAP group was longer than that in control group (P <0.01).The total time of invasive mechanical ventilation and oxygen therapy in BiPAP group was lower than that in control group (P < 0.05).④ The incidence of retinopathy of prematurity (ROP)and bronchopulmonary dysplasia (BPD)in BiPAP group was lower than that in control group.Conclusion BiPAP can significantly reduce the use of invasive mechanical ventilation after the failure of InSurE,thereby decreases the oxygen toxicity and barotrauma hazards.

End-to-end venous anastomosis using the microvascular anastomotic in head and neck detects reconstruction with free flaps / 中华显微外科杂志

Objective To assess the reliability and useness of using a coupling device for end-to-end venous anastomosis in patients undergoing free-tissue transfer in head and neck reconstruction.Methods Twelve patients undergoing surgical resection and head and neck defects were repaired with fibular flap,anterolateral thigh flap and radial forearm flap.The microvascular anastomotic device was used to perform venous anastomosis in these cases.Flap survival and thrombosis of the venous anastomoses were determined.Results There were no flap losses due to venous thrombosis in this series.The venous anastomosis was usually coupled in about 5.3 minutes and appear as an obviously time savings compared with performing a hand-sewn venous anastomosis.Conclusion The microvascular coupler is excellent in end-to-end venous anastomosis and certainly less taxing on the surgeon when compared with standard suture techniques.

Culture methods for primary human umbilical cord mesenchymal stem cells / 中国组织工程研究

BACKGROUND:How to get a lot of stable and dynamic human umbilical cord mesenchymal stem cels is stil a difficulty. OBJECTIVE:To investigate the best culture way of human umbilical cord mesenchymal stem cels by comparing tissue explant, enzyme digestion, enzymolysis methods. METHODS:Ten fresh umbilical cords were isolated to human umbilical cord mesenchymal stem cels by using tissue explant, enzyme digestion, and enzymolysis methods, respectively. Hereafter, we compared cels harvested using three culture methods in terms of the time for the primary cels to creep, successful rates of cel-culturing, and curves of cellgrowth. Surface markers of cels were detected by flow cytometry and multiple differentiations of cels were detected. RESULTS AND CONCLUSION: The time for the primary cels to creep out in the enzymolysis and enzyme digestion groups had no significant difference, but both of them were significantly shorter than that in the tissue explant group (P < 0.01). The successful rate of primary cellculture in the enzymolysis group was significantly higher than that in the other two groups. The cellproliferations of three groups had no significant difference. The cellsurface markers and differentiation ability of the third generation of human umbilical cord mesenchymal stem cels cultured by enzymolysis method met the characteristics of mesenchymal stem cels. In conclusion, the enzymolysis method can shorten the time for primary human umbilical cord mesenchymal stem cels to creep out and increase the successful rates of primary human umbilical cord mesenchymal stem cels.

Biocompatibility and osteoinductive activity of nano-hydroxyapatite/chitosan/poly(lactide-co-glycolide) scaffoldsin vitro / 中国组织工程研究

BACKGROUND:Studies have found that combination of two of chitosan (CS), nano-hydroxyapatite (nHA) and poly(lactide-co-glycolide) (PLGA) can improve the mechanical properties and biocompatibility of the composite stent in certain extent as wel as improve osteogenic differentiation of the cels, but there is a certain distance from the ideal bone tissue engineering scaffolds. OBJECTIVE:To study biocompatibility and osteoinductive activity of nHA/CS/PLGA scaffolds with different proportions in vitro. METHODS: nHA/CS/PLGA scaffolds were prepared at mass ratio of 10:10:80, 10:20:70, 20:10:70 respectively by particle leaching method. And human bone marrow stem cels (hBMSCs) were co-cultured with these scaffolds in vitro. Adhesion, proliferation, and osteoinductive activity of these scaffolds were examined qualitatively and quantitatively by growth curve of hBMSCs on scaffolds. Gene expression of alkaline phosphatase activity and osteocalcin was detected by RT-PCR. RESULTS AND CONCLUSION: hBMSCs could be attached, proliferated, and osteoinduced better on the nHA/CS/PLGA scaffold with the mass ratio of 20:10:70, compared to the other two groups of scaffolds. The differences were significant statisticaly (P< 0.05). Alkaline phosphatase and osteocalcin expressions were respectively higher in the scaffold with the mass ratio of 20:10:70 after 9-27 days of co-culture and 15-27 days of co-culture, in comparison with the other two groups of scaffolds. These findings indicate that the nHA/CS/PLGA scaffolds with the mass ratio of 20:10:70 demonstrated preferable biocompatibility and osteogenic inductivity, which is expected to be a promising scaffold material for bone tissue engineering.

Comparative study of woman false positive rate in exercise treadmill before or after menopause / 中国医师进修杂志

Objective To analyse the rate of coincidence to suspected coronary artery disease (CAD) patient between positive exercise treadmill testing (TET) and coronary angiography (CAG) test.Method Two hundred and sixty-eight chest pain patients positive in TET were performed CAG test,coronary stenosis exceed 50% was diagnosed CAD. Results One hundred and seventy-six patients (65.67%) was diagnosed by CAG, 105 male and 71 female in them. Ninety-two (34.33%) patients was negative in CAG test. The false positive rate of TET between post-menopause patients (30.12%, 25/83 ) andmale patients (28.08%, 41/146) was no significant difference(P > 0.05 ); the difference of false positive rate between pro-menopause patients (66.67%, 26/39) and male patients (28.08% ,41/146) was statistical significance (P < 0.01 ). Conclusions The positive rate of CAG can be greatly improved by screening the chest pain patients though TET before CAG, if the positive in TET performed CAG only. TET false positive rate of pro-menopause female is significantly higher than post-menopause female or male.

Effect of EGF on expression of EGFR and EGF mRNA in the injuried lung tissue of neonatal premature rats exposed to hyperoxia / 中国病理生理杂志

AIM:To investigate the effect of exogenous epidermal growth factor(EGF) on expression of EGFR and EGF mRNA of the injuried lung tissue of neonatal premature rats exposed to hyperoxia.METHODS:The neonatal Sprague-Dawley rats of 21-day gestational age model of hyperoxia induced lung injury were made by continually inhaling 95% oxygen.The model rats were divided into two groups randomly,the EGF trail group and the NS control group.The other rats were taken into the air control group.Each group was divided into three subsets:a(1-3 days),b(4-6 days) and c(1-6 days) according to different application times of EGF or NS.Rats in sub groups were executed and the lung tissues were removed at postnatal 3th,7th,14th day respectively.Using immunohistochemistry method,the expression of EGF-R of lung tissues in different groups was observed,and the expression of EGF mRNA was determined by reverse transcriptase polymerase chain reaction(RT-PCR).RESULTS:The expression of EGF mRNA increased by degrees following the increasing postnatal days.Compared with the air control group,the expression of EGF-R and EGF mRNA increased in the hyperxia group at 7th day and 14th day.The expression of EGF-R increased in corresponding hyperxia NS control group at 14th day(P