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Abstract Objective To investigate the relationship between lactate acid level and hospitalization mortality in neonatal necrotizing enterocolitis (NEC). Method Paediatric-specific critical care database collected clinical data from the intensive care unit of Children's Hospital Affiliated to Zhejiang University Medical College from 2010 to 2018. Clinical and laboratory examination information of NEC patients was collected and divided into the death group and discharge group to find out the risk factors affecting the prognosis through univariate and multivariate analysis. Results Among 104 NEC neonates, the admission age was 7.5 days and the weight was 2.03 kg. Comparing the death group with the discharge group, there were significant differences in therapeutic regimen, pH, serum albumin, total protein, creatinine and lactate acid. Multivariate and threshold effect analysis showed that lactate acid had a linear correlation with hospital mortality, and newborns who died in the hospital had much higher lactate levels than those who were discharged. The mortality of NEC newborns increased by 40-45% for every 1 mmol/L increase in lactate acid level. Conclusions There was a correlation between lactate acid level and hospital mortality in newborns with NEC, and lactate acid level was an important index to evaluate the prognosis of NEC.
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Objective:To investigate the therapeutic effects of Tiaojing Xiaozhi Decoction combined with auricular acupoint embedding acupuncture on polycystic ovary syndrome in obese patients. Methods:A total of 120 obese cases of polycystic ovary syndrome (spleen and kidney deficiency syndrome) treated in Ningbo Municipal Hospital of Traditional Chinese Medicine from July 2020 to June 2021 were included in this study. They were randomly assigned to undergo treatment with either Tiaojing Xiaozhi Decoction (Chinese medicine group, n = 40), auricular acupoint embedding acupuncture (ear acupuncture group, n = 40), or Tiaojing Xiaozhi Decoction and auricular acupoint embedding acupuncture (combined therapy group, n = 40). Traditional Chinese medicine (TCM) syndrome integral, body mass index, waist circumference, hip circumference, waist- to-hip ratio, testosterone, luteinizing hormone, follicle-stimulating hormone, luteinizing hormone/follicle-stimulating hormone, estradiol, prolactin, recombinant human leptin, adiponectin, tumor necrosis factor α, interleukin-6, and clinical efficacy were compared among groups before and after treatment. Results:Total response rate in the combined therapy group was 87.5%, which was slightly but not significantly, higher than 77.5% in the Chinese medicine group and 80.0% in the ear acupuncture group, and there was no significant difference in total response rate among the three groups (all P > 0.05). After treatment, TCM syndrome integral in the combined therapy was (10.40 ± 2.38) points, which was significantly lower than (12.35 ± 3.32) points in the Chinese medicine group and (14.18 ± 3.51) points in the ear acupuncture group ( F = 14.78, P < 0.05). The body mass index, waist circumference, hip circumference, and waist-to-hip ratio in the combined therapy group were superior to those in the Chinese medicine and ear acupuncture groups ( F = 4.11, 18.59, 3.62, 13.33, all P < 0.05). Luteinizing hormone and luteinizing hormone/follicle-stimulating hormone in the combined therapy group were superior to those in the Chinese medicine and ear acupuncture groups (all P < 0.05). After treatment, recombinant human leptin and adiponectin in the combined therapy and Chinese medicine groups were superior to those measured before treatment (both P < 0.05). After treatment, only adiponectin was significantly increased in the early acupuncture group compared with before treatment ( P < 0.05). After treatment, tumor necrosis factor α and interleukin-6 in the combined therapy group were (4.12 ± 1.54) μg/L and (3.09 ± 1.41) ng/L respectively, which were significantly decreased compared with before treatment ( t = 21.66, 10.42, both P < 0.05). Conclusion:Tiaojing Xiaozhi Decoction combined with auricular acupoint embedding acupuncture can decrease body mass index, fat factor, and inflammatory factor levels, which can help decrease sex hormone levels and TCM syndrome integral, and has an obvious therapeutic effect on polycystic ovary syndrome.
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Resumen La enterocolitis necrotizante (ECN) es la urgencia más frecuente en el periodo neonatal asociada al sistema digestivo; afectando principalmente a los neonatos pretérmino con muy bajo peso al nacer. La etiología continúa siendo desconocida, se considera una enfermedad multifactorial, donde la prematuridad es el principal factor de riesgo, todo esto relacionado con la inmadurez del tracto gastrointestinal, una motilidad disminuida que genera una mayor permeabilidad en la mucosa y con esto facilita la translocación bacteriana. Su diagnóstico suele ser muy complejo y suele pasar desapercibido en muchas ocasiones generando una mortalidad importante de hasta el 30% donde su principal complicación es la perforación intestinal y el consiguiente shock séptico. Las opciones terapéuticas se dividen en 2 grupos: médico y quirúrgico, ambos con complicaciones importantes que afectan el desarrollo de los niños que la padecen donde las más importantes abarcan desde alteraciones del crecimiento y neurodesarrollo hasta síndrome de intestino corto y desnutrición.
Abstract Necrotizing enterocolitis (NEC) is the most common emergency in the neonatal period associated with the digestive system; mainly affecting preterm neonates with very low birth weight. Etiology remains unknown, considered a multifactorial disease, all this related to the immaturity of the gastrointestinal tract, a decreased motility that generates greater permeability in the mucosa and with this facilitates bacterial translocation. Diagnosis is usually very complex and often goes unnoticed on many occasions leading to a significant mortality of up to 30% where its main complication is intestinal perforation and consequent septic shock. Therapeutic options are divided into 2 groups: medical and surgical, both with major complications affecting the development of children with it where the most important from growth and neurodevelopmental alterations to short bowel syndrome and malnutrition.
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Infant, Premature , Enterocolitis, Necrotizing/diagnosis , Costa RicaABSTRACT
Objective From May 2010 to May 2013 and from June 2013 to June 2016, we compared the clinical analysis of patients with necrotizing enterocolitis (NEC) in the Department of Pediatrics, studied incidence rate of NEC and the relationship between stages of NEC and prognosis, and compared the prognosis between the two three-year periods to provide the experience of diagnosis and treatment for clinical practice in the future. Methods The clinical data of patients diagnosed with NEC were retrospectively analyzed according to the diagnostic criteria of modified Bell staging classification using SPSS statistical software package. Early diagnosis rate and prognosis were compared between the two three-year periods. P＜0.05 showed that statistical significance was found. Results From May 2010 to May 2013, 40 cases of NEC were diagnosed in our hospital, among which 8 was in the first stage (20%),24 in the second stage (60%),and 8 in the third stage (20%) . The number of premature infants was 32, accounting for 80% , among which 25 cases were infants with very low birth weight accounting for 62.5% and 8 cases were full-term infants, accounting for 20% (P＜0.05) . In the study, 32 cases (80%) received traditional treatment, which was effective in stage Ⅰ. During the second stage, two abandoned the treatment was confirmed death in the follow-up, two underwent surgery successfully due to the progression of the disease and four (25%) died in the hospital. Statistic significance of treatment of internal medicine was found when comparing stage Ⅰ with stage Ⅱ (P＜0.05) . Ten children underwent surgery, among which one gave up treatment after the surgery because of financial problems and was found dead in the follow-up and four (60%) died in the hospital. The comparison of surgical treatment in patients in stage Ⅱ and Ⅲ showed no statistical significance (P＞0.05) . Fatality rates were statistically significant (P＜0.05) . From June 2013 to June 2016, 41 children were diagnosed with NEC in our hospital, including 24 cases in stage Ⅰ (59%), 14 in stage Ⅱ (34%), and 3 in stage Ⅲ (7%) . The number of premature infants was 33, accounting for 80%, among which 26 cases were infants with very low birth weight accounting for 62.5% and 8 cases were full-term infants, accounting for 20% (P＜0.05) . In the study, 35 cases (85.3%) received traditional treatment, which was effective in stage Ⅰ. During the second stage, one underwent surgery successfully due to the progression of the disease. Statistic significance of treatment of internal medicine was found when comparing stage Ⅰ with stage Ⅱ (P＜0.05) . Four children underwent surgery, among which one gave up treatment after the surgery because of financial problems and was found dead in the follow-up and the surgery was successful in other three. The comparison of surgical treatment in patients in stage Ⅱ and Ⅲ showed statistical significance (P＜0.05) . Fatality rates were statistically significant comparing the two three-year periods (P＜0.05) . The comparison of the rates of early diagnosis in the two three-year periods showed statistically significance (P＜0.001) . Conclusion Early diagnosis of NEC is the key to reduce mortality. Intestinal fatty acid binding protein (I-FABP) is a serological marker for early diagnosis of NEC. As an important factor, the reduction of the incidence of premature birth will result in the drop in the incidence of NEC.
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The diabetic foot is a group of syndromes in which ischemia, neuropathy and infection leads to tissue breakdown resulting in morbidity and possible lower extremity amputation. The diagnosis is based on clinical criteria investigations. It is imperative that such patients are managed by a team of Physician, Surgeon, Social care worker, Physiotherapist and a Podiatrist. In this study we included 100 diabetic foot patients in the age group of 30 to 80 years. The study was done for a period of one year. 47% of our patients had Meggit Wagner grade 3 and 10% had grade 5. 27% of the patients had renal failure and 30% had anemia. These patients were subjected to non-enteric culture of blood under sterile precautions. 80% of our patients showed positive culture. The organisms commonly isolated were Staphylococcus aureus, beta haemolytic Streptococcus and Klebsiella pneumoniae. Less commonly isolated were Citrobacter species, Proteus mirabilis and anaerobes. 40% of patients with positive culture went on to have lower extremity amputation. Thus we concluded that non enteric culture in diabetic foot disease has prognostic significance and the spectrum of infection in diabetic foot disease is polymicrobial in nature and at par with the literature.
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AIM:To investigate the expression of FIZZ1 ( found in inflammatory zone 1) in the lung tissues from smoking-induced chronic obstructive pulmonary disease (COPD) rats and to explore the potential role of FIZZ1 in air-way remodeling in COPD. METHODS:The male Wistar rats (n=70) were used in the study. The rats were randomly di-vided into COPD group and control group. The rat model of COPD was established by inhaling cigarette smoke alone. HE staining was used to observe the pathological changes of the lung tissues for firming the successful modeling. The protein ex-pression of FIZZ1 in the lung tissues at different time points was determined by immunohistochemistry and Western blot. The inflammatory cells in bronchoalveolar lavage fluid (BALF) were counted. The concentrations of interleukin 4 (IL-4) and tumor necrosis factor α (TNF-α) in both BALF and serum were measured by ELISA. RESULTS:HE staining showed that the inflammatory response was chronic in the lung tissues of model group at 20th week and gradually showed pathologi-cal features of COPD. The results of immunohistochemistry and Western blot showed that in the model group, FIZZ1 protein expression was significantly increased (P<0. 05). Total number of inflammatory cells in BALF in the cigarette smoked rats was significantly higher from 4th week (P<0. 05). Within a certain range, compared with the control group, the concen-trations of inflammatory cytokines IL-4 and TNF-α in both BALF and serum were increased in the model group ( P <0.05). CONCLUSIONS:FIZZ1 may be involved in the occurrence and development of COPD with the mechanism of causing infiltration of inflammatory cells and secretion of cytokines.
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Objective To investigate the protective effect and its potential molecular mechanism of Nec-1 on cytotoxicity induced by cyclosporine A.Methods MRTEpiC, glomerular endothelial cell MGEC and mesangial cell line MMC were co-administered with Nec-1 and cyclosporin A in mouse renal tubular epithelial cell line, and then MTT assay and soft agar clone formation assay were used to detect Cell growth curve changes, clonal formation ability.Apoptosis was detected by flow cytometry.The expression of cyclin D1, CDK4, CDK2, Cyclin E and apoptosis-related Caspase 3 were detected by Western blot.Results After cyclosporine A action, the cell growth ability was significantly decreased and the clone formation ability was significantly decreased(P<0.05).Cyclin D1, CDK4, CDK2 and Cyclin E were significantly increased(P<0.05), but the ratio of apoptosis and the expression of Caspase 3 did not change.Nec-1 has obvious protective effect on cytotoxicity induced by cyclosporine A, which can increase the cell growth ability and clone formation ability, and reduce the cell cycle-related proteins Cyclin D1, CDK4, CDK2, Cyclin E.Conclusion Nec-1 has cytotoxic effect on the glomeruli and renal tubular cells by up-regulating the cell cycle-related proteins Cyclin D1, CDK4, CDK2 and Cyclin E, while Nec-1 has protective effect.
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Necrotising enterocolitis (NEC) is the most commonly acquired gastrointestinal disease of neonates, particularly the very preterm (gestation 90%) of the NEC cases occurred in neonates on enteral feeding. Studies have shown that milk (whether EBM or formula) fed to neonates was not sterile and were further contaminated during collection, transport, storage and/or feeding. Other investigators have reported a reduction in the incidence of NEC when they improved infection control measures and hygienic procedures in handling milk. It is, therefore, hypothesised that the most common cause of NEC is due to the feeding of neonates, particularly the vulnerable very preterm small neonates, with milk heavily contaminated during collection at source, transport, storage and/or feeding. Because of the immaturity of the immune system of the neonates, excessive inflammatory response to the pathogen load in the gut leads to the pathogenesis of NEC.
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Aim To investigate the cytotoxic effect and mechanism of ampelopsin sodium ( AMP-Na ) on hu-man lung adenocarcinoma cell line GLC-82 alone or combined with carboplatin ( CBP ) . Methods The cytotoxic effect of human lung adenocarcinoma cell line GLC-82 was investigated by 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide ( MTT ) colori-metric assay. Ultrastructure change of apoptotic GLC-82 cells was observed with transmission electron micro-scope. The changes of the cell apoptosis and the ex-pression of caspase-3 were analyzed with flow cytome-ter. Results Combined with AMP-Na, the IC50 of CBP decreased from (17. 10 ± 4. 78) mg·L-1 to tron microscope and flow cytometric analysis, the apop-tosis and necrosis ratios also increased in the combina-tion group. The necrosis ratios increased from (2. 56 ± 0. 41 )% to ( 71. 83 ± 5. 43 )% ( P<0. 01 ) . The ex-pression of caspase-3 was increased significantly after treated with AMP-Na or combined with CBP. Conclu-sions There is a synergistic cytotoxic effect on GLC-82 cells treated with AMP-Na combined with CBP. Ap-optotic cells and necrotic cells are found in GLC-82 cells treated with AMP-Na alone or combined with CBP. One of the mechanisms to induce apoptosis is probably that activation of caspase-3 mediates signal transduction pathway in cells.
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Common causes of pneumoperitoneum in neonates includes necrotising enterocolitis (NEC), specific infections, gastro intestinal obstruction, iatrogenic causes, idiopathic focal intestinal perforation, perforation secondary to intra thoracic pathology, mechanical ventilation etc. Primary peritoneal drainage and exploratory laparotomy remain the definitive management of pneumoperitoneum in neonates. Here we report a case of suspected spontaneous idiopathic intestinal perforation managed conservatively with monitoring of vital signs. The neonate had an uneventful recovery. This case highlights the need to identify infants with benign or non surgical causes of pneumoperitoneum thus avoiding unnecessary laparotomies and referrals in these vulnerable neonates.
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The authors report a case of neonatal amebiasis presenting with vomiting, refusal to feeds, abdominal distension and mucoid stools. The diagnosis was made on the basis of clinical appearance of stools and the presence of Entameba Histolytica. The purpose of this report is to alert to the possibility of amoebiasis in newborns, if baby presents with NEC like picture in an endemic area and to send the stool sample immediately to examine for trophozoites, especially because the diarrheal stool starts autolyzing within 30 min of defecation. This 14-day-old newborn, who was possibly infected with orally given jaggery solution is presented. He was successfully treated with intravenous tinidazole.
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Entamoeba histolytica/isolation & purification , Entamoebiasis/diagnosis , Female , Humans , Infant, NewbornABSTRACT
Objective To observe the curative effects of malignant brain swelling after brain injury by using the operations of standard large Craniotomy decompression and removal of necrotic brain tissues. Methods 80 cases of malignant brain swelling after severe brain injury were observed. The standard decompression surgery of large era-niotomy routine were used in 40 cases,while the operations of standard large craniotomy decompression and removal of necrotic brain tissues were used in the other 40 cases. The curative effects of the results after 15 days and six mon-ths were analyzed. Results The incidence of intracranial hypertension (37.5%, 15/40 ) and brain tissue incisional hernia (32.5% ,13/40)of the group using standard large craniotomy decompression and removal of nee-rotic brain tissues treatment was significantly lower than that of simple standard large craniotomy decompression treat-ment group [15.0% (6/40) vs 10.0% (4/40)] after 15 days (P<0.05 ). The prognosis excellent rate ( good + re-sidual) of the group using standard large Craniotomy decompression and removal of necrotic brain tissues treatment was significantly higher (60.0%) than that of simple standard large craniotomy decompression treatment group (40.0%) after six months (P<0.05 ). Conclusion The operations of standard large craniotomy decompression and removal of necrotic brain tissues can effectively reduce the intracranial hypertension of malignant brain swelling after trauma injury,and reduce mortality and morbidity of severe brain injury.
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Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal population. The aim of this study is to evaluate surgical indication and prognostic factors of NEC. Clinical data of seventy patients, diagnosed as NEC between January 2000 & January 2007, were reviewed retrospectively. Fifty-seven patients had medical treatment and 7 of them died. Thirteen patients who presented with pneumoperitoneum on plain abdominal film or were refractory to medical treatment received surgical treatment, and 5 of them died. All the expired 12 patients weighed less than 2500g. Twenty out of seventy patients showed thrombocytopenia, and 11 patients of them died. The finding of pneumoperitoneum and thrombocytopenia could be the most important surgical indication. Prematurity, low birth weight and thrombocytopenia were related to a bad prognosis. NEC patients who presents with these findings must be considered for close observation and intensive care.
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Humans , Infant, Newborn , Emergencies , Enterocolitis, Necrotizing , Infant, Low Birth Weight , Pneumoperitoneum , Prognosis , Retrospective Studies , ThrombocytopeniaABSTRACT
OBJECTIVES: The purpose of this study is to evaluate the association between hematologic abnormalities and severity in neonate with NEC. METHODS: A retrospective chart review was established of 69 premature infants with a diagnosis of NEC who had been admitted to Pochon CHA University neonatal intensive care unit between Jan 2001 and Jun 2004. Infants were divided into three groups according to Bell's criteria. The association between perinatal and clinical manifestation, hematologic abnormalities and severity in neonate with NEC was evaluated. RESULTS: Nadir platelet counts, neutropenia, I:T ratio, CRP and base excess were associated with severity of NEC, but coagulation disturbances (DIC) were not significantly correlated with severity of NEC. CONCLUSION: These preliminary results may be helpful to predict the severity and to improve the outcome in neonate with NEC.