Prenatal Genetic Diagnosis and Origin Analysis of Rare Complete Translocation Trisomy 18 / 中山大学学报(医学科学版)

ObjectiveTo discuss the origin of rare abnormal karyotypes of fetuses with high risk of trisomy 18 revealed by non-invasive prenatal testing （NIPT） and its impact on fertility. MethodsThe cytogenetic and molecular genetic analyses were performed on the abnormal chromosomes of a prenatally diagnosed fetus with rare complete translocation trisomy 18. Using the keywords “translocation trisomy 18” or “trisomy 18 translocation” in both Chinese and English， we searched PubMed， CNKI， SinoMed， WanFang Data， CQ VIP and the Chinese Medicine database. The relevant case series were retrieved and critically appraised. ResultsG-banded karyotype analysis showed that the maternal karyotype was 46，XX，t（9；18）（q31.2；q23） and the fetal karyotype was 47， XN， t （9； 18） （q31.2；q23）mat， +18， which was a rare complete translocation type of trisomy 18. The SNP array revealed the fetus had increased copy number of chromosome 18 and two complete chromosome 18 inherited from the mother with balanced chromosomal translocation. Literature search found two children with complete translocation trisomy 18 reported abroad. Both of them had trisomy 18 phenotype and originated from the balanced translocation between parental chromosome 18 and other chromosomes. ConclusionNIPT gives an effective advance warning of trisomy 18. SNP array not only improves the detection rate of chromosomal abnormalities， but also helps identify the origin. The karyotype is still the gold standard for prenatal diagnosis.

Literature Study on Current Status of Traditional Chinese Medicine for Chronic Atrophic Gastritis Based on PubMed and Web of Science Databases / 中国实验方剂学杂志

Objective:To review and summarize the current research status of traditional Chinese medicine（TCM） for the treatment of chronic atrophic gastritis（CAG），provide references and hints for relevant studies，and contribute to the further understanding of TCM and the application of TCM in the treatment of CAG with scientific evidence. Method:The PubMed and Web of Science databases were searched for relevant literature on the treatment of CAG with TCM from their establishment to August 31，2020. Eligible randomized controlled trials （RCTs） and animal studies were included according to the inclusion and exclusion criteria，and then the information of the included studies was extracted，summarized，and organized for further analysis. Result:A total of 4 RCTs and 21 animal studies （including 13 papers on compound studies，3 papers on single herb studies，and 5 papers on monomer studies） about TCM treatment for CAG were included in this study. RCTs showed that TCM could work well in improving the pathological state of gastric mucosa and clinical symptoms in patients. However，there were problems of low study quality，and non-uniform diagnostic criteria for gastric mucosal pathology and clinical efficiency evaluation. Animal experiments mainly focused on the study of drug mechanism exploration，and their results showed that TCM treatment of CAG was characterized by multi-target action. However，the animal experiments also had some problems such as inconsistence of CAG animal model establishment，positive drug selection，drug intervention methods as well as intervention cycles among different experiments. Conclusion:The efficacy of TCM in the treatment of CAG has gradually gained global recognition，but there is still a need for further standardization and unification of research methods. In the future，high-quality clinical trials and standardized animal experiments are still needed to conduct in-depth studies on the time for intervention，intervention methods，active ingredients and mechanisms of TCM，so as to make contributions to the full understanding and application of TCM in the treatment of CAG.

Historical Evolution and Modern Clinical Application of Qingxin Lianzi Yin / 中国实验方剂学杂志

Qingxin Lianzi Yin （QXLZY）， as an ancient classical formula for clearing the heart and nourishing the Yin， was composed of nine herbs （Scutellariae Radix， Ophiopogonis Radix， Lycii Cortex， Plantaginis Semen， Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle， Nelumbinis Semen， Poria， Astragali Radix and Ginseng Radix et Rhizoma）， coming from Prescriptions of the Bureau of Taiping People's Welfare Pharmacy. It could clear away the heart-fire， promote the interaction of the heart and kidney， replenish Qi and Yin， and stop strangury-turbidity. It was used to treat gonorrhea of urination， seminal emission， restlessness， wasting-thirst and so on. At present， the usage and dosage of QXLZY and its addition and subtraction are different in clinical practice. Most of the studies just focus on its clinical efficacy， and there is few review literature reflecting its historical evolution. Based on this， this paper systematically clarified the historical evolution， composition， preparation， interpretation， function， and modern clinical application of QXLZY. This work has been explained the historical evolution of QXLZY， and found that it was wildly used in modern clinical， especially suitable for the treatment of chronic urinary system diseases. At the same time， QXLZY also had significant therapeutic effects on neurasthenia， stomatitis， diabetic nephropathy and other aspects. Through the comprehensive analysis of ancient and modern literature， this work explores the true connotation of QXLZY from the perspective of traditional Chinese medicine theory， which can point out the direction of the clinical application and positioning of this famous classical formula after it comes into the market， and also can provide reference basis for its subsequent in-depth research and development.

Effect of concentrated growth factors combined with guided tissue regeneration in treatment of classII furcation involvements of mandibular molars / 北京大学学报(医学版)

OBJECTIVE@#Tissues loss due to periodontal disease is typically treated by a variety of regenerative treatment modalities, including bone grafts, guided tissue regeneration (GTR) and growth factors, to reform the supporting tissues of teeth. Concentrated growth factors (CGF) are produced by centrifuging blood samples at alternating and controlled speeds using a special centrifuge. The purpose of this study was to evaluate whether GTR could improve the effect of CGF combined with bone graft in the treatment of classII furcations of mandibular molars.@*METHODS@#In the present study, thirty-five classII furcation involvements were included and randomly divided into two groups. The experimental group (n=17) accepted GTR combined with CGF and bone graft therapy, and the controlled group (n=18) accepted CGF combined with bone graft therapy. The clinical examinations and cone beam computed tomography (CBCT) were performed at baseline and 1 year post-surgery. Comparisons of clinical and CBCT data before and after operation between the experimental group and the control group were made.@*RESULTS@#The clinical and CBCT data of both groups were not statistically different at baseline (P>0.05). At the end of 1 year post-surgery, the clinical parameters of both groups were significantly improved (P<0.001). The probing depths of the experimental group were (4.81±1.95) mm and (3.56±1.94) mm, respectively, significantly higher than the changes of the control group (P<0.001). The vertical and horizontal attachment gains of the experimental group were (4.11±1.98) mm and (3.84±1.68) mm, respectively, significantly higher than the changes of the control group (P<0.001). At the end of 1 year post-surgery, the experimental group showed significantly higher bone gain at vertical and horizontal directions compared with those of the control group: (3.84±1.68) and (3.88±2.12) mm, respectively (P<0.001).@*CONCLUSION@#Within the limitation of the present study, GTR showed positive role in the effect of CGF combined with bone graft in the treatment of classII furcation involvements of mandibular molars.

Study on obsessive-compulsive symptoms and influencing factors in college students with left-behind experience / 中华疾病控制杂志

Objective To understand the obsessive-compulsive symptoms (OCS) and relative influencing factors among college students with left-behind experience. Methods College students with left-behind experience were selected from three universities in Anhui Province. The Chinese Obsessive-Compulsive Inventory-Revised (OCI-R), Rosenberg Self-Esteem Scale (RSES), Self-Rating Depression Scale (SDS) and self-edited basic situation questionnaires were used to measure the OCS, self-esteem, depression and left-behind experience. Multivariate logistic regressions model was applied to examine the influential factors of OCS. Results A total of 2 291 college students with left-behind experience were investigated. The detection rate for OCS in college students with left-behind experience were 26.5%. Regarding the OCS in college students with left-behind experience, significant differences were found in the following aspects: frequency of meeting with parents, parenting style, conflicts with caregivers, smoking and drinking (all P<0.05). Logistic regression analysis showed that caregiver adopts strict parenting style (OR=1.300, 95%CI:1.025-1.649,P=0.030), indulgent parenting style (OR=1.372, 95%CI:1.017-1.852, P=0.038), smoking (OR=1.982, 95%CI:1.305-3.011, P=0.001), depressive symptoms (OR=2.423, 95%CI:1.954-3.005, P<0.001), medium self-esteem (OR=0.604, 95%CI:0.481-0.759, P<0.001) and high self-esteem (OR=0.488, 95%CI:0.362-0.659, P<0.001) were influencing factors of OCS. Conclusions The prevalence rate of OCS among college students with left-behind experience is high. Some interventions should be taken to reduce the OCS among college students with left-behind experience.

Orthodonticorthognathic treatment stability in skeletal class III malocclusion patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate stability of skeletal hard tissues, dental hard tissues and soft tissues after orthodonticorthognathic treatment in a long term. This study reviewed longitudinal changes in orthodontic-orthognathic patients of skeletal class III malocculsion, using lateral cephalometric radiographs in 3-12 years after treatment in comparison to treatment finishing.@*METHODS@#Twenty-two patients with skeletal Class III malocclusion following orthodontic-orthognathic surgery in Peking University School and Hospital of Stomatology from January 1, 2000 to January 1, 2009 were observed. The lateral cephalometric radiographs of the following stages were collected: treatment finishing (T1), 3 to 12 years after treatment (T2). Statistical analyses of cephalometrics were evaluated. Paired student t test was performed by SPSS 17.0.@*RESULTS@#Data of all the 22 patients were studied in longitudinal timeline after treatment and 3-12 years after treatment. From T1 to T2, we evaluated 11-SN (angle between the upper incisors axis and SN plane), 11-NA angle (angle between the upper incisors axis and NA plane), 11-NA mm (perpendicular distance from upper incisors to NA plane), 11-41 (angle between the upper incisors axis and lower incisors axis), 41-NB angle (angle between lower incisors and NB plane), 41-NB (perpendicular distance from lower incisors to NB plane), 41-MP angle (angle between lower incisors and GoGn plane), and IMPA [angle between lower incisor and mandibular plane (tangent line to submandibular border)]. Most hard tissues of the teeth remained stable but upper anterior teeth angulations decreased, indicating by significantly reducing 11-SN (T1: 110.98°±6.77°; T2: 109.21°±5.80°; P=0.005); reducing 11-NA (T1: 28.31°±6.80°; T2: 26.49°±6.18°; P=0.002); increasing 11-41 (T1: 123.51°±8.14°; T2: 125.7°±10.01°; P=0.035). From T1 to T2, we also evaluated SNA (angle of sella-nasion-A-point), SNB (angle of sella-nasion-B-point), ANB (angle of A-point-nasion-B-point), GoGn-SN (angle between GoGn and SN plane), GoGn-FH (angle between GoGn and Frankfort plane), Y axis (angel between Sella-Gn and Frankfort plane), N-ANS (distance from nasion point to ANS point), ANS-Me (distance from ANS point to Menton point), N-Me (distance from nasion point to Menton point), ANS-Me/N-Me% (proportion of ANS-Me to N-Me), and FMA (angle between Frankfort and mandibular plane), Wits appraisal (horizontal distance between points A and B on functional occlusal plane). Skeletal hard tissues also remained relatively stable, only N-Me value changed significantly with a decreasing facial height (T1: 124.98°±11.98°; T2: 122.4°±11.05°; P=0.024). From T1 to T2, we finally evaluated FH-NsPg angle (angle between NsPg and Frankfort plane), H angle (angel between H line and NB), FH-A'UL angle (angle between A'UL and Frankfort plane), FH-B'LL angle (angle between B'LL and Frankfort plane), UL-LL (angle between UL and LL), UL-EP (distance between UL and E line), LL-EP (distance between LL and E line), Sn-H (perpendicular distance between Sn point and H line), Nls-H (distance of nose-lip-sulcus to H line), Li-H (lower lip to H line), Si-H (lower lip sulcus to H line), and NLA (nasolabial angle, angle of Cm-Sn-UL-point). Soft tissues changes were observed in decreasing UL-EP [T1: (-2.78±2.20) mm; (-3.29±2.44) mm; P=0.02] and H angle (T1: 8.27°±3.71°; 7.32°±3.83°; P=0.006). Other soft tissues remained relatively stable by retruding upper lip position and chin changes with no statistical significance.@*CONCLUSION@#Orthodontic-orthognathic treatment can improve esthetics and occlusal function in patients of skeletal class III malocclusion with a stable long-term outcome.

Clinical analysis of outpatients with ametropia in Hebeisheng Eye Hospital / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To perform a clinical analysis of 1 500 cases of outpatients with ametropia in Hebeisheng Eye Hospital,to provide a theoretical basis for diagnosis,treatment,and prevention of patients with ametropia.METHODS:Totally 1500 cases (2840 eyes) of outpatient with ametropia were chosen as the research objects in Hebeisheng Eye Hospital from June 2013 to July 2014.All cases were treated with TOPCON RM-8800 computer optometry instrument for objective optometry,and used TOPCON phoropter for subjective optometry.The combination of the two instruments was taken to determine the diopter later.Diopter and axial distribution of the myopic astigmatism and hyperopic astigmatism were observed,age of astigmatic patient,distribution of astigmatism axis were observed as well.Meanwhile,a total of 150 cases were chosen randomly to measure their corneal curvature,anterior chamber depth,axial length and other static refractive index.All indexes were compared with those of the normal people subsequently,such as amplitude of accommodation,negative relative accommodation,positive relative accommodation,sensitivity of accommodation and other dynamic refractive index.RESULTS:Ametropia types of all patients were mainly simple myopia,simple myopia astigmatism,compound myopic astigmatism,simple hypermetropia,simple hyperopia astigmatism,compound hyperopic astigmatism and mixed astigmatism,the proportion were 38.99％,3.27％,23.94％,4.68％,1.34％,13.52％,15.25％ respectively.There were 773 eyes with myopia astigmatism.The proportion of people with a myopia astigmatism diopter of above-0.25 to-0.50,-0.75 to -1.00,-1.25 to-1.50,above-1.75 were 31.05％,38.55％,16.56％,13.84％.There were 421 eyes with hyperopia astigmatism,the proportion of people with hyperopia astigmatism diopter of 0.25-0.50,0.75-1.00,1.25-1.50,＞1.75 were 26.60％,24.94％,16.63％,31.83％.Static refractive index of 150 patients (300 eyes) showed that corneal curvature was (41.23 ± 2.43) φ/D,anterior chamber depth was 3.71 ± 0.43mm,axial length 23.45 ± 1.43mm.Dynamic refractive index showed that the amplitude of accommodation 10.56±2.32D,negative relative accommodation 2.31 ±0.47D,positive relative accommodation-1.82-± 0.67D,sensitivity of accommodation 11.34±2.21D.All kinds of static and dynamic refractive indexes,the length of ocular axis were statistically different from those of the normal population (P ＜ 0.05).Regular astigmatism number rate in 1 194 cases of astigmatism eyes of 3-7 years old,8-18 years old,19-45 years old,46-60 years old were 35.85％,11.98％,45.64％,6.53％.Among 150 cases of patients (300 eyes),there were 152 eyes of equivalent sphere mirror ＜-0.5D,48 eyes of equivalent sphere mirror ≥ 0.5D,100 eyes of equivalent sphere mirror between-0.5D to 0.5D.And there were 150 eyes of equivalent sphere mirror ＜-0.5D,50 eyes of equivalent sphere mirror ≥0.5D,100 eyes of equivalent sphere mirror between-0.5D to 0.5D in a total of 300 eyes of 150 normal people.CONCLUSION:The 1500 cases of patients with ametropia (2 840 eyes) contains mainly simple myopia and compound myopic astigmatism,diopter range in myopia astigmatism were chiefly-0.25 to-0.50,-0.75 to-1.00,hyperopia diopter range consists of ＞ 1.75 mostly,among the patients with astigmatism,the older the age,the bigger the number of people with irregular astigmatism,static and dynamic refractive index of patients with ametropic eye shows apparent difference with that of the normal population.

Common questions and suggestions of evaluation for NDA of TCM / 中国中药杂志

According to the existing Provisions for Drug Registration (SFDA Order No. 28), applications for new drugs of traditional Chinese medicine are divided into two parts: the applications for drug clinical trial and for drug production (including new drug certificate). It will last for about 10 years from the application for drug clinical trial to get approving, and it also remains many problems and the low probability to succeed. From the sight of pharmaceutical review, there are mainly two aspects of regulatory compliance and technical issues, mainly for changes without approval of the competent authorities of the country. For example, sample preparation and approval of clinical trial process are significant changes. Technical problems are reporting incomplete data or information submitted does not comply with the technical requirements for review, such as: production process validation does not provide information, the preparation of samples for clinical trials and field inspection, production information, or the information provided does not meet the technical requirements. This paper summarizes the frequently asked questions and to make recommendations to advise applicants concerned, timely detection of problems, avoid risk, improving the quality and efficiency of the application for registration.

Macronutrients and energy in milk from mothers of premature infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the dynamic changes in macronutrients and energy in human milk from mothers of premature infants.</p><p><b>METHODS</b>A total of 339 human milk samples were collected from 170 women who delivered preterm or full-term infants in the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital between November 2012 and January 2014. Macronutrients (proteins, fats and carbohydrates and energy were measured using a MIRIS human milk analyzer and compared between groups.</p><p><b>RESULTS</b>In milk samples from premature infants' mothers, the protein levels were the highest in colostrum (2.22±0.49 g/dL), less in transitional milk (1.83±0.39 g/dL), and the least in mature milk (1.40±0.28 g/dL) (P<0.01), and the levels of fats (2.4±1.3 g/dL vs 3.1±1.1 g/dL; P<0.01), carbohydrates (6.4±0.9 g/dL vs 6.6±0.4 g/dL; P<0.05) and energy (55±9 kcal/dL vs 62±8 kcal/dL; P<0.01) were significantly lower in colostrum than in transitional milk. The protein levels in colostrum from premature infants' mothers were significantly higher than those in colostrum from term infants' mothers (2.22±0.49 g/dL vs 2.07±0.34 g/dL; P<0.05). The colostrum from mothers of premature infants with a gestational age of ≤30 weeks had significantly higher protein levels than those from mothers of premature infants with gestational ages of 30(+1)-33(+6) weeks and ≥34 weeks (2.48±0.68 g/dL vs 2.11±0.25 g/dL and 2.22±0.39 g/dL respectively, P<0.05); the energy levels in colostrum from mothers of premature infants with a gestational age of ≤30 weeks group (51±6 kcal/dL) were significantly lower than those in colostrum from mothers of premature infants with a gestational age of 30(+1)-33(+6) weeks (58±8 kcal/d; P<0.05). The carbohydrate levels in transitional milk from mothers of premature infants with a gestational age of ≤30 weeks were significantly higher than those in transitional milk from mothers of premature infants with gestational ages of 30(+1)-33(+6) weeks and ≥34 weeks (P<0.05). The protein levels in mature milk from mothers of premature infants with a gestational age of 30(+1)-33(+6) weeks were significantly higher than those in mature milk from mothers of premature infants with gestational ages of ≤30 weeks and ≥34 weeks (P<0.05).</p><p><b>CONCLUSIONS</b>The levels of macronutrients and energy in milk from mothers of premature infants vary significantly between colostrum, transitional milk, and mature milk. Protein levels are significantly higher in colostrum from premature infants' mothers than in colostrum from term infants' mothers, but the significant difference is not seen for mature milk. Macronutrient and energy levels show significant differences between milk samples from mothers of premature infants with different gestational ages, so as to meet different needs of premature infants.</p>

Risk factors for Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae colonization in neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To identify risk factors for Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) colonization in neonates hospitalized in the neonatal intensive care unit (NICU).</p><p><b>METHODS</b>A case-control study was conducted. The case group included nine patients colonized with KPC-Kp between 1 August 2012 and 31 April 2013 and the controls were selected randomly from patients without KPC-Kp colonization during the same period. Univariable analysis and multivariable logistic regression analysis were conducted to identify risk factors for KPC-Kp colonization.</p><p><b>RESULTS</b>The univariable analysis showed 11 factors associated with KPC-Kp colonization: gestational age, birth weight, length of hospital stay, duration of mechanical ventilation, congenital heart disease, peripherally inserted central catheter, surgical operation, duration of intravenous nutrition, carbapenems use, duration of carbapenems use and glycopeptides use. The multivariable logistic regression analysis showed that exposure to more than 4 days of carbapenems use (OR=18.7, 95%CI: 1.98-175.5, P=0.01) was an independent risk factor for KPC-Kp colonization. The intervention to control KPC-Kp colonization included contact isolation, active surveillance, and rational use of antibiotics.</p><p><b>CONCLUSIONS</b>Exposure to prolonged use of carbapenems is an independent risk factor for the development of KPC-Kp colonization in neonates hospitalized in the NICU.</p>

Clinical evaluation of remineralization potential of casein phosphopeptide amorphous calcium phosphate nanocomplexes for enamel decalcification in orthodontics / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Enamel decalcification in orthodontics is a concern for dentists and methods to remineralize these lesions are the focus of intense research. The aim of this study was to evaluate the remineralizing effect of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) nanocomplexes on enamel decalcification in orthodontics.</p><p><b>METHODS</b>Twenty orthodontic patients with decalcified enamel lesions during fixed orthodontic therapy were recruited to this study as test group and twenty orthodontic patients with the similar condition as control group. GC Tooth Mousse, the main component of which is CPP-ACP, was used by each patient of test group every night after tooth-brushing for six months. For control group, each patient was asked to brush teeth with toothpaste containing 1100 parts per million (ppm) of fluoride twice a day. Standardized intraoral images were taken for all patients and the extent of enamel decalcification was evaluated before and after treatment over this study period. Measurements were statistically compared by t test.</p><p><b>RESULTS</b>After using CPP-ACP for six months, the enamel decalcification index (EDI) of all patients had decreased; the mean EDI before using CPP-ACP was 0.191 ± 0.025 and that after using CPP-ACP was 0.183 ± 0.023, the difference was significant (t = 5.169, P < 0.01). For control group, the mean EDI before treatment was 0.188 ± 0.037 and that after treatment was 0.187 ± 0.046, the difference was not significant (t = 1.711, P > 0.05).</p><p><b>CONCLUSION</b>CPP-ACP can effectively improve the demineralized enamel lesions during orthodontic treatment, so it has some remineralization potential for enamel decalcification in orthodontics.</p>

Percutaneous balloon pulmonary valvuloplasty for critical pulmonary stenosis in infants under 6 months of age and short and medium term follow-up / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the effect and results of short and medium periods of follow-up of percutaneous balloon pulmonary valvuloplasty for critical pulmonary stenosis of neonates and infants under 6 months of age.</p><p><b>METHODS</b>Between January 2002 and December 2008, 34 consecutive patients aged from 13 to 175 days with critical pulmonary valvular stenosis underwent percutaneous balloon valvuloplasty. Patients records, catheterization data, angiograms and echocardiograms were reviewed. Patients were followed up for 6 months to 4 years (mean 25.5 months) by means of clinical examination and Doppler echocardiography.</p><p><b>RESULTS</b>The pulmonary valvuloplasty was accomplished in 32 (94%) of 34 attempts. Immediately after dilation, right ventricular systolic pressure (RVSP) decreased from (96 ± 28) mm Hg (1 mm Hg = 0.133 kPa) (49 ± 20) mm Hg (P < 0.01), the transvalvular peak to peak systolic gradient (ΔP) decreased from (89 ± 25) mm Hg to (25 ± 12) mm Hg (P < 0.01), and the right ventricular/aortic systolic pressure ratio decreased from 1.2 ± 0.5 to 0.7 ± 0.3 (P < 0.01). One patient died because of cardiac tamponade following rupture of the pulmonary valve annulus, 2 patients developed pericardial effusion, 3 patients had infundibular spasm, 3 patients had a pre-dilation by small balloon and 1 patient had weakened femoral artery pollex. After a follow up period of 6 months to 4 years 3 of 31 patients lost to follow-up. Repeat valvuloplasty was performed in 5 patients (3 neonates), no patient required surgery, and the other 23 patients did not undergo further intervention, a mean peak systolic Doppler gradient of (20 ± 13) mm Hg was found and no significant pulmonary regurgitation was seen.</p><p><b>CONCLUSIONS</b>Percutaneous balloon pulmonary valvuloplasty was effective and safe for the treatment of critical pulmonary stenosis of neonates and infants under 6 months of age with good short and medium term results.</p>

Clinical features of parenteral nutrition associated cholestasis in preterm infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and influential factors of parenteral nutrition associated cholestasis (PNAC) in preterm infants.</p><p><b>METHOD</b>A total of 159 infants with birth weight less than 2000 grams and/or gestational age less than 34 weeks were exposed to parenteral nutrition for longer than 14 days in NICU during the period from July 2007 to June 2009. Of these infants, 40 cases who had PNAC were aligned into the PNAC group, and the other 119 cases without PNAC were aligned into the non-PNAC group. PNAC occurring time, duration, the degree of PNAC and hepatic injury were observed. Logistic regression analysis was performed to evaluate the correlative factors of PNAC.</p><p><b>RESULT</b>PNAC occurred about (3.3 ± 1.6) weeks after beginning PN, usually lasted for (13.3 ± 5.4) weeks. The maximum direct bilirubin was (135.2 ± 65.5) µmol/L. Of the PNAC patients, 73.7% suffered from hepatic injury. Hepatic injury usually occurred (6.6 ± 3.0) weeks after beginning PN, and lasted for (9.5 ± 5.4) weeks. The highest alanine aminotransferase (ALT) was (121.5 ± 48.4) U/L. The logistic regression of the possible correlative factors showed that time to start enteric feeding, persistence time of PN, asphyxia, small for gestational age, intracranial hemorrhage, were related to PNAC.</p><p><b>CONCLUSION</b>The prognosis of PNAC was good. Early enteral feeding, shorter time of PN, avoidance of the complications such as asphyxia and sepsis, were the important measures to lower PNAC.</p>

Clinical review of enteral feeding of extremely low birth weight infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To review the clinical data of enteral feeding of extremely low birth weight infants (ELBWI), and analyze the influencing factors.</p><p><b>METHOD</b>From Jan. 2000 to Jan. 2010, data of 31 ELBWI from Peking Union Medical College Hospital were retrospectively collected. ELBWI were assigned to different groups according to the time achieving full enteral feeding, comparison was done between two groups for enteral feeding.</p><p><b>RESULT</b>Twenty-four infants were analyzed, their mean gestational age was (29.0 ± 1.8) weeks (26.14 - 34.43 weeks), birth weight (882 ± 67) g (730 - 970 g), there were 11 infants in group A, whose time for achieving full enteral feeding was (27 ± 6)days, there were 13 infants in group B, whose time achieving full enteral feeding was (46 ± 10)days. The ratio of asphyxia (18.2% vs. 61.5%, P = 0.047), duration of umbilical vein catheterization longer than 10 days (18.2% vs. 61.5%, P = 0.047), and duration of mechanical ventilation longer than 14 days (27.3% vs. 76.9%, P = 0.038) in group A was higher than in group B. The milk volume on the 21st and 28th day in group A was much more than that in group B [(88.9 ± 35.4) ml vs. (37.4 ± 34.9) ml, P = 0.002; (121.1 ± 37.4) ml vs. (53.2 ± 33.1) ml, P = 0.000]. There were no significant differences between the two groups in gestational age, birth weight, patent ductus arterious, erythrocytosis, dysglycemia, sepsis, the time to begin enteral feeding, the beginning milk volume, the adding milk volume in the 1st, 2nd week, and the milk volume on the 3rd, 7th, 14th day.</p><p><b>CONCLUSION</b>Asphyxia, duration of umbilical vein catheterization, and duration of mechanical ventilation are likely to influence the enteral feeding of ELBWI, ELBWI with successful enteral feeding could show good tolerance in the 3rd week. But individual program should be made for enteral feeding of ELBWI, because enteral feeding could be influenced by multiple factors.</p>

Maple syrup urine disease of neonates: report of two cases and review of literature / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze and summarize clinical manifestation of maple syrup urine disease (MSUD) of neonates.</p><p><b>METHODS</b>Data of two cases with neonatal MSUD and the reports of 15 cases seen in the past 15 years in China were reviewed and analyzed.</p><p><b>RESULTS</b>There was an increasing number of reports of cases with neonatal MSUD. All the 17 cases had the symptom of poor feeding between 3 h and 8 d after birth; 7 cases had family history; 14 cases showed progressive neurologic signs. Odor of maple syrup occurred in 8 cases. Blood levels of branched-chain amino acids (BCAA) significantly increased in 13 cases and 6 neonates were diagnosed using tandem mass spectrometry. Urinary levels of BCAA and metabolite elevated in 12 cases and 5 neonates were diagnosed using gas chromatography-mass spectrometry. MRI/CT demonstrated abnormal signal in 10 cases. Twelve cases died or their parents gave up treatment and one case had cerebral palsy; 4 cases were treated with BCAA-free formula milk and showed improved outcome.</p><p><b>CONCLUSION</b>Newborns with MSUD often had early appeared non-specific symptoms with poor feeding and lethargy, most cases later showed an odor resembling maple syrup and neurologic signs. For patients who were suspected of having MSUD, blood and urine concentrations of BCAA should be tested for early diagnosis. Specific MRI edema signal from brain suggests the possibility of MSUD. Early intervention and treatment after diagnosis, with compliance of parents, would improve the patient's outcome.</p>

Protective effects of omega-3 fish oil on lead-induced impairment of long-term potentiation in rat dentate gyrus in vivo / 生理学报

In order to evaluate the effect of omega-3 fish oil supplement by gavage (0.4 mL/100 g body weight) on the chronic lead-induced (0.2% lead acetate) impairments of long-term potentiation (LTP) in rat dentate gyrus (DG) in vivo, we designed the experiments which were carried out in four groups of newborn Wistar rats (the control, the lead-exposed, the control with fish oil treatment and the lead-exposed with fish oil treatment, respectively). The excitatory postsynaptic potential (EPSP) and population spike (PS) amplitude were measured in the DG of rats with above different treatments at the age of 80-90 d in response to stimulation applied to the lateral perforant path. The results showed (1) postnatal chronic lead-exposure impaired LTP measured on both EPSP slope and PS amplitude in DG area of the hippocampus; (2) in the control rats, omega-3 fish oil had no effect on LTP while in the lead-exposed rats, omega-3 fish oil had a protective effect on LTP. These results suggest that omega-3 fish oil supplement could protect rats from the lead-induced impairment of LTP. Omega-3 fish oil might be a preventive substance in reducing LTP deficits induced by lead.

Effects of chronic administration of melatonin on spatial learning ability and long-term potentiation in lead-exposed and control rats / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To explore the changes in spatial learning performance and long-term potentiation (LTP) which is recognized as a component of the cellular basis of learning and memory in normal and lead-exposed rats after administration of melatonin (MT) for two months.</p><p><b>METHODS</b>Experiment was performed in adult male Wistar rats (12 controls, 12 exposed to melatonin treatment, 10 exposed to lead and 10 exposed to lead and melatonin treatment). The lead-exposed rats received 0.2% lead acetate solution from their birth day while the control rats drank tap water. Melatonin (3 mg/kg) or vehicle was administered to the control and lead-exposed rats from the time of their weaning by gastric gavage each day for 60 days, depending on their groups. At the age of 81-90 days, all the animals were subjected to Morris water maze test and then used for extracellular recording of LTP in the dentate gyrus (DG) area of the hippocampus in vivo.</p><p><b>RESULTS</b>Low dose of melatonin given from weaning for two months impaired LTP in the DG area of hippocampus and induced learning and memory deficit in the control rats. When melatonin was administered over a prolonged period to the lead-exposed rats, it exacerbated LTP impairment, learning and memory deficit induced by lead.</p><p><b>CONCLUSION</b>Melatonin is not suitable for normal and lead-exposed children.</p>

Establishment and clinical application of a new real time PCR assay for simultaneous detection of human herpesvirus-6A and human herpesvirus-6B / 中华儿科杂志

<p><b>OBJECTIVE</b>Human herpesvirus 6 (HHV-6) isolates are classified into two variants, HHV-6A and HHV-6B, based on distinct genetic, antigenic and biological characteristics. HHV-6 has been associated with encephalitis in children recently. This study aimed to establish a real time PCR assay for simultaneous detection of the two subtypes of HHV-6, and apply this new assay to children with suspected encephalitis, then analyze the relationship between the infection with HHV-6 and encephalitis in children.</p><p><b>METHOD</b>The universal primers and variant-specific TaqMan probes were designed based on the highly conserved sequences of the DNA polymerase gene (U38) of HHV-6. The 5' end of the probes for HHV-6A and HHV-6B was labeled with the fluorescein reporter tetrachloro-6-carboxyfluorescein and 6-carboxyfluorescein (6-FAM), separately, while the 3' end were quenched with 6-carboxy-tetramethylrhodamine. The real time PCR assay for simultaneous detection of HHV-6A and HHV-6B was established. Then, the plasmids of HHV-6A and -6B which were diluted by a 10-fold series from 10(9) to 10(0) copies/microl, together with controls were used for testing both sensitivity and specificity of the real time PCR assay. The cerebrospinal fluid (CSF) specimens from 445 cases of suspected encephalitis were tested with this real time PCR and positive samples were then sequenced.</p><p><b>RESULT</b>Both HHV-6A (strain ZJ-159) and HHV-6B (strain GS) were positive on the real time PCR assay. There were no cross-reaction with herpes simplex virus type 1, type 2 (HSV-1, HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis B virus, Staphylococcus aureus, Mycoplasma pneumoniae and human DNA. A linear regression curve was obtained when plotting Ct values against the log10 of the viral DNA input for both subtypes of HHV-6. The sensitivity threshold was 10 copies/microl for the real time PCR. HHV-6 positive rate by the real time PCR assay was 4.72% (21/445), including 4 cases with HHV-6A infection, 16 cases of HHV-6B infection and 1 case with mixed HHV-6A and HHV-6B infection. The new PCR assay usually took 2 to 3 hours to provide results.</p><p><b>CONCLUSION</b>This new real time PCR assay can simultaneously detect both subtypes of HHV-6, and have high specificity and sensitivity. It will provide an early and sensitive diagnosis of HHV-6 encephalitis in children.</p>

Retrospective analysis of elective caesarean section and respiratory distress syndrome in the term neonates / 中华儿科杂志

<p><b>OBJECTIVE</b>Severe respiratory distress syndrome (RDS) caused by pulmonary surfactant (PS) deficiency is described not only in preterm infants but also in term babies delivered via caesarean section, especially before the onset of labour (elective caesarean section). Once RDS of term neonates happened, mechanical ventilation is needed, and the infants were at high risk of developing further complications such as persistent pulmonary hypertension of neonates (PPHN), pulmonary air leak and cardiovascular instability, even fatal outcome cannot be avoided. The present study aimed to analyze the association between the elective caesarean section and respiratory distress syndrome (RDS) in term neonates, and to determine the related factors and outcomes of RDS cases in neonatal intensive care unit (NICU) and neonatology ward.</p><p><b>METHODS</b>A retrospective study was conducted at the NICU and the Neonatology Ward of A center (Children's Hospital of Zhejiang University) and the NICU of center B (Obstetrics and Gynecology Hospital of Zhejiang University) on 90 term infants who were diagnosed as RDS between June 2006 and June 2008. The general clinical data, mode of delivery, severity of the radiological sign, pulmonary surfactant (PS) application, the onset time and duration of mechanical ventilation, the ratio of PaO(2) to FIO(2) before mechanical ventilation, oxygenation index (OI), duration of oxygen supplementation, the length of hospital stay and complications including pulmonary air leaks (pneumothorax, pulmonary interstitial emphysema), PPHN, systemic hypotension and ventilator-associated pneumonia (VAP) were collected. The gestational age distribution was studied in RDS cases delivered by elective caesarean section, and the comparative analysis and non-conditional logistic regression analysis wer performed for clinical characteristics and risk factors between the RDS cases with or without complications. P < 0.05 was considered to be significant.</p><p><b>RESULTS</b>There were 88 episodes of elective caesarean section in 90 RDS patients. The proportion of elective caesarean section was 97.8% (88/90). The number of RDS cases was reduced gradually with the increase of gestational age and the constituent ratio of RDS at 39 w and at 40 w was significantly lower than that of 37 w and 38 w. By logistic regression analysis, the onset time of mechanical ventilation > 12 h independently predicted complications in RDS of term neonates (odds ratio 12.667, 95% confidence interval, i.e., CI 1.455 to 110.300, P = 0.021). Moreover, there was a significant difference in the admission age (t = 11.833, P = 0.001), severity of the radiological findings (t = 4.85, P = 0.028), PS application (t = 11.911, P = 0.002), the onset time of mechanical ventilation (t =10.051, P = 0.018), the ratio of PaO(2) to FIO(2) before mechanical ventilation (chi(2) = 4.184, P = 0.005), OI > 25 (t = 4.737, P = 0.03), duration of oxygen supplementation (chi(2) = 10.475, P = 0.001), systemic hypotension (t = 11.020, P = 0.01) and the length of hospital stay (t = 9.827, P = 0.002) between the two centers.</p><p><b>CONCLUSION</b>Severe RDS can occur in term babies after elective caesarean section, gestational age at the time of elective caesarean section may also be important for RDS in term neonates. The onset time of mechanical ventilation > 12 h independently predicted complications in RDS of term neonates. The main complications of RDS in term neonates were PPHN, pulmonary air leaks and systemic hypotension. Early diagnosis, early intervention can significantly reduce the complications, alleviate the severity and shorten their time for oxygen therapy and their length of stay in NICU in term RDS infants.</p>

Protection effects of S-adenosyl-L-methionine on lead-exposed rats during development and its mechanism of long-term potentiation / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the effects of S-adenosyl-L-methionine (SAM) on blood lead concentration and oxidative stress of tissue in prenatal and postnatal lead-exposed rats, and evaluate the potential reparation exerted by SAM on paired-pulse facilitation (PPF) and long-term potentiation (LTP) in lead-exposed rat.</p><p><b>METHODS</b>Pregnant Wistar rats were randomly divided into three groups: control, lead-exposed and lead-exposed with SAM treatment groups. Lead-exposed rats drank 1.5 g/L lead acetate solution through pregnancy until weaning and then the pups received 20 mg/kg SAM or saline daily intraperitoneally depending on their group. Control group rats drank tap water throughout the experiment. At the postnatal 44-60 days, all the pup rats were given an extracellular recording measured in dentate gyrus (DG) area of hippocampus. The blood lead concentration and oxidative stress in liver, brain and hippocampus were also detected.</p><p><b>RESULTS</b>The blood lead concentration in lead-exposed group was higher (159. 3 +/- 10. 9 microg/L) in comparing with those of control group (27.5 +/-3.8 microg/L) and lead +SAM group (33.1 +/-9.5 microg/L) (F=213.5, P<0.01). A significant recovery of liver, brain glutathione (GSH) and malondialdehyde (MDA) level was clearly produced in lead-exposed rats after SAM treatment (P <0.05). Chronic lead exposure during development impaired LTP measured on field excitatory postsynaptic potential (EPSP) [(112 +/-2.1)%] compared with control rats [(131+/-4.5)%] and the impaired LTP could be significantly increased by SAM treatment [(120 +/- 2.6)%] (F = 26. 1, P <0. 05).</p><p><b>CONCLUSION</b>SAM might be beneficial for treatment of lead intoxication, especially in the rescue of learning and memory impairment induced by lead and should deserve more detailed research.</p>