Research progress of mild hypothermia combined with neuroprotective agents in the treatment of neonatal hypoxic-ischemic encephalopathy / 中国小儿急救医学

Neonatal hypoxic-ischemic encephalopathy(HIE) is one of the critical diseases in neonatal ward, which can lead to neonatal death or serious neurological sequelae.Mild hypothermia treatment is currently accepted.Although it could reduce the mortality and the risk of neurological sequelae of neonates with moderate and severe HIE to a certain extent, there were still some children who died or left neurological dysfunction.Neuroprotective agents play an important role in anti-excitotoxicity, anti-oxidation, anti-inflammatory and anti-apoptosis.This review provided the research progress of the combination of mild hypothermia and neuroprotective agents in the treatment of neonatal HIE.

Therapeutic effect of peripheral arteriovenous exchange combined with intravenous gamma globulin on neonatal hemolysis / 中国综合临床

Objective To observe the effect of peripheral arteriovenous exchange combined with intravenous gamma globulin in the treatment of neonatal hemolysis. Methods Seventy children with neonatal hemolysis admitted to the first affiliated Hospital of China Medical University from January 2013 to May 2018 and who met the indications for peripheral arteriovenous exchange were selected as the study subjects. The patients were divided into peripheral arteriovenous exchange group and ＂peripheral arteriovenous exchange+gamma globulin＂ group by random number table method,with 35 cases in each group. Baseline data of the two groups, changes of serum bilirubin before and after treatment, partial blood biochemical indicators, hospitalization time and jaundice regression time were observed. Results The levels of serum bilirubin ((241. 5±48. 1),(184. 6± 26. 3),(166. 3± 18. 5),(133. 5± 20. 8) μmol／L) in peripheral arteriovenous exchange + gamma globulin group were significantly lower than those in peripheral arteriovenous exchange group ((299. 3±32. 5),( 225. 7± 38. 9),(195. 4± 21. 1),( 173. 8± 35. 4) μmol／L) at 12,24,48 and 72 hours after treatment,the difference was significant (P＜0. 05). RBC in children in two groups after treatment was(4. 3±0. 8)×1012／L,(4. 2±1. 0)×1012／L vs. before(5. 2±1. 1)×1012／L,(6. 4±1. 3)×1012／L,Hb after treatment in both groups was (125. 8 ± 11. 2) g／L,( 124. 9 ± 10. 5) g／L vs. before ( 148. 9 ± 26. 5) g／L, (159. 3±14. 6) g／L and reticulocyte count after treatment in both groups were (7. 6±2. 1)%,(7. 3±1. 8)%vs. ( 5. 2 ± 1. 3)%, ( 3. 1 ± 0. 5)% were significantly improved, but the peripheral arteriovenous exchange+gamma globulin group was significantly better than the peripheral arteriovenous transfusion group, the difference was statistically significant ( all P＜0. 05) . The hospitalization time (10. 3±1. 9) d and jaundice regression time ( 8. 6 ± 0. 5) d in the peripheral arteriovenous exchange + gamma globulin group were significantly lower than those in the peripheral arteriovenous exchange group ((15. 5±2. 6) d,(10. 0±1. 1) d) . The difference was statistically significant ( t＝ 9. 553, 6. 855, P＜0. 05) . The children who had re-hemolytic after treatment in the peripheral arteriovenous exchange + gamma globulin group were significantly lower than the peripheral arteriovenous exchange group ( 5. 7%( 2／35) vs. 25. 7%(9／35)),the difference was statistically significant ( χ2 ＝ 5. 285, P ＝ 0. 022 ) . Conclusion Peripheral arteriovenous exchange combined with intravenous gamma globulin is effective in the treatment of neonatal hemolysis. It can significantly reduce serum bilirubin,improve blood biochemical parameters,shorten hospitalization time and jaundice regression time,and is safe and reliable.

Associated factors of acute kidney injury in critically ill neonates / 中国小儿急救医学

Objective To study the incidence of acute renal injury ( AKI), related clinical risk factors and recent prognosis in critically ill neonates. Methods The study was a retrospective analysis from January 2016 to December 2016 in the neonatal care department of General Hospital of Shenyang Military Region and the First Hospital Affiliated to China Medical University. We collected the perinatal data,clinical data,biochemical indexes and short-term prognosis. Logistic regression analysis was used to identify the risk factors. Results The incidence of AKI in critically ill neonates was 13. 11%(32/244),and the probability of poor prognosis was 62. 50%(20/32). Gestational age,birth weight,1 min and 5 min Apgar score,con-sciousness,mechanical ventilation,blood pH,blood glucose,blood urea nitrogen,white blood cell and red cell distribution width were the related factors for AKI in critically ill neonates. Logistic regression analysis showed that consciousness(OR=4. 542,95%CI 1. 176-17. 539,P=0. 028),mechanical ventilation(OR=0.267,95%CI 0.101-0.705,P = 0.008),5 min Apgar score(OR = 0.750,95% CI 0.605-0.930,P =0. 009),blood urea nitrogen value(OR=1. 074,95%CI 1. 006-1. 146,P=0. 030)were identified as the inde-pendent risk factors of AKI. ConclusionThe incidence of AKI is high in critically ill neonates. Consciousness,mechanical ventilation,5 min Apgar score,blood urea nitrogen value are identified as independent risk factors for AKI.

Clinical significance of serum vascular endothelial growth factor on recurrence and/or metastasis following surgery in patients with differentiated thyroid carcinoma / 中国基层医药

Objective To evaluate the expression of serum vascular endothelial growth factor ( VEGF ) on recurrence and/or metastasis following surgery in patients with differentiated thyroid carcinoma,and to ana1yze the relationship between serum VEGF and serum thyroglobulin levels.Methods The serum samples were obtained from 25 patients with pulmonary metastasis, 43 cases with locoregional recurrence, 30 cases without recurrence and/or metastasis and 30 normal subjects were selected as control.The levels of serum VEGF were analyzed by enzyme-linked immunosorbent assay( ELISA) ,the levels of serum thyroglobulin were analyzed by chemiluminescence method. Results The level of serum VEGF[(864.3 ±200.3)ng/L] in patients with pulmonary metastasis were significantly higher than that in patients with locoregional recurrence[(393.3 ±96.3)ng/L],without recurrence and /or metasta-sis[(276.6 ±47.7)ng/L] and normal subjects[(268.6 ±36.9)ng/L](t=11.04,14.34,14.66,all P0.05).It showed linear correlation between serum VEGF and thyroglobulin levels on recurrence and/or metastasis following surgery in patients with differentiated thyroid carcinoma ( r=0.902 2, P<0.001) .Conclusion The serum VEGF level was significantly elevated in patients with locoregional recurrence and pulmonary metastases, the serum VEGF can be used as a auxiliary index to predict recurrence and /or metastasis following surgery in patients with differentiated thyroid carcinoma.

Reconstruction of large external nose defect with forehead flap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the role of forehead flap in large external nasal defect reconstruction.@*METHOD@#We retrospectively reviewed the clinical and follow-up data of 11 patients with large or full-thickness external nasal defects, which were reconstructed with single-or two-stage interpolated or island forehead flaps from January 2007 to June 2011. All patients were male,defects of 9 cases were resulted from resection of skin malignant tumor and traumatic defect in 2 cases. The average diameter of defects was 3.3 cm (2.5-5.0 cm). Four cases had alar full thickness defect. The supratrochlear and angular artery of the elders (>70 yrs) and patients with suspicious peripheral blood vessel lesions were scanned before the surgery by Doppler ultrasonic. The defects were reconstructed by two-stage interpolated flap in 7 cases; five cases were reconstructed by single-stage island flap technique. A nasolabial flap based on piriform aperture was turned into the nasal cavity to reconstruct the lining.@*RESULT@#All defects were repaired successfully. All tissue flap survived and the scar was not conspicuous. One patient had nostril stenosis with mild nasal congestion complain at the 6th postoperative month.@*CONCLUSION@#The forehead flap, interpolated or island, can be used safely and effectively to repair the large external nasal defect in experienced hands.

Dynamic expression of E2F1 in lung of premature rats with hyperoxia-induced chronic lung disease and its significance / 中南大学学报(医学版)

OBJECTIVE@#To determine the dynamic expression of E2F1 in lung of premature rats with hyperoxia-induced chronic lung disease and the relation between E2F1 and pulmonary fibrosis.@*METHODS@#Premature Wistar rats at 21 days gestation were randomly and equally divided into a hyperoxia group and a room air group. The hyperoxia group was continuously exposed to hyperoxia (90%) while the air group in room air. Lung tissues in the 2 groups were obtained at 3, 7 and 14 days after exposing to either room air or hyperoxia. The changes of pulmonary histopathology at different time points were observed by hematoxylin and eosin staining; the severity of pulmonary fibrosis was evaluated; and the expression of E2F1 in lung tissue was detected by immunohistochemistry and Western blot.@*RESULTS@#After 3 days of hyperoxia, no significant interstitial fibrosis was observed; while after 7 days in the hyperoxia group, interstitial fibrosis was observed. These changes became more obvious after 14 days of prolonged hyperoxia exposure. No significant difference in the expressions of E2F1 protein was found between the hyperoxia group and the room air group 3 days postnatally (P>0.05). The expression of E2F1 in the hyperoxia group significantly increased 7 days and 14 days postnatally (P<0.05, P<0.01).@*CONCLUSION@#Abnormality of E2F1 expression is involved in the pathological process of the proliferation of lung fibroblasts in hyperoxia-induced chronic lung disease neonatal rats, and it plays an important role in lung fibrosis.

The etiology and treatment of neonatal acute heart failure / 中国小儿急救医学

Neonatal acute heart failure is a common critical illness,and also one of the material cause of perinatal death. It is difficult for early diagnosis due to the different characteristics and clinical manifestation between neonate and older children, which leads to the difficulty of diagnosis timely and affect the condition adversely. This article introduced the common etiology, characteristics of clinical manifestation, diagnosis and treatment of neonatal acute heart failure.

The dynamic study of total antioxidative capacity and malondialdehyde in the liver of newborn rats induced by hyperoxia / 中国小儿急救医学

Objective To determine the levels of total antioxidative capacity(TAOC) and malondialdehyde(MDA) in liver exposed to hyperoxia,and to explore whether oxygen inhalation could cause liver injury in newborn rats.Methods Sixty-four newborn rats which were less than 12-hour-old were enrolled in this study.The rats were randomly divided into hyperoxia group(FiO2=0.85,n=32) and control group(air,n=32).Eight rats in each group were randomly sacrificed to obtain liver tissues at 1d,3d,7d and 14d.The TAOC of liver homogenates was detected by chemical colorimetry,and the MDA level of liver homogenates was measured by thiobarbituric acid test.Results In the hyperoxia group,TAOC in liver increased on the 1st day[(3.60±0.28)U/mg prot vs(3.39±0.19)U/mg prot,P<0.05];TAOC began to decreased on the 3rd day,and significantly lower than that of control group on the 14th day [(3.10±0.15)U/mg prot vs (3.56±0.14)U/mg prot,P<0.01].In the hyperoxia group,the MDA level increased on the 3rd day[(3.58±0.11)nmol/mg prot vs(2.82±0.14)nmol/mg prot,P<0.01],and reached a peak on the 7th day[(3.58 ±0.11)nmol/mg prot vs(2.82±0.14)nmol/mg prot,P<0.01],then decreased but still remained higher than control group on the 14th day [(2.92±0.18)nmol/mg prot vs(2.77 ±0.09)nmol/mg prot,P<0.01].Conclusion Too more MDA in liver and TAOC decrease may cause liver injury in newborn rats exposed to hyperoxia.With the oxygen inhalation time prolonging,the liver injury aggravation.

Clinical study on high risk factors for intraventricular hemorrhage in premature infants / 中国小儿急救医学

Objective To study the prevalence of intraventficular hemorrhage(IVH)in premature infants using bedside cranial ultrasound scans and to analyze the associated laboratory results.Methods 114 patients admitted between February 2003 and March 2004 were eligible for the study.NAS-2000A 3D ultrasound instrument for bedside ultrasound detection were used.All the premature infants were detected for blood gas analysis,blood cell analysis(red blood cell counting,haemoglobin and haematocrit),prothrombin time (PT),fibrinogen(FIB)and activated partial thromboplastin time(APTT)in the first 24 hours of life.Results There were 34 IVH cases in 114 patients(29.8%).The ineidence of IVH of premature infants below 34 weeks gestation was 43.8%,which was higher than that of infants above 35 weeks gestation.The incidence of IVH of infants whose birth weight were below 1 500 g is 58.8%,which was higher than that of infants whose birth weight were above 1 500 g.The incidence of IVH increased with decreasing gestational age and birth weight.As compared with the values of infants without IVH,HB and HCT of the IVH infants were higher (P＜0.05);PT and APTT of the IVH inrants were longer(P＜0.01);hypoxia,hypercapnia and acidosis were more common in IVH infants(P＜0.05).Conclusion Risk factors such as short gestational age,low birth weight,increased HB and HCT,prolongation of PT and APTT,hypoxia,hypercapnia and acidosis may be associated with the IVH in premature infants.

Ultrastructural study of alveolar type Ⅱ cells in young rats with lipopolysaccharide-induced acute lung injury / 国际儿科学杂志

Objective Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are common and life-threatening disease in children with mortality as high as 40%-70%. Alveolar type Ⅱ cells (ATII cells),characterized by the presence of lamellar bodies (LBs),synthesize and secret surfactant proteins (SPs),which contribute significantly to surfactant homeostasis and pulmonary immunity.The functions of ATⅡ cells including pulmonary surfactant production are autocratically dominated by the structural integrity of ATII cells.Our study is focused on the ultrastructural alterations of AT Ⅱ cells in rats with lipopolysaccharide(LPS)-induced ALI.Methods Rat ALI models were established by intraperitoneal injection of LPS (4 mg/kg).0.9 % NS with same amount was given in the normal control group.The rats were randomly chosen and sacrificed at 24, 48 and 72 hrs after LPS injection (8 rats at each time point).Lung samples (1 mm3 of the size) were obtained from the lower parts of left lungs and fixed with 2.5% glutaraldehyde for the transmission electron microscope examination.Results The microvilli around ATII cells disappeared and the number of LBs increased at 24 hrs after LPS administration.LBs rearranged like a ring around the nuclei.It was commonly seen that two nuclei were present in one AT Ⅱ cell.Vacuole-like deformity prominently occurred in cytoplasm at 48 hrs.Giant LBs presented at the same time.The shapes of nuclei were irregular and some of the borders were unclear at 48 and 72 hrs.The remnant of ruptured LBs scattered in cytoplasm at 72 hrs.The number of LBs reduced obviously.Karyolysis occurred in some of the nuclei.Conclusions The ALI-related alterations of ATII cells characterized by the changes of LBs,nuclei,and nucleoli were time-dependent. ATII cell injury was serious at 48 and 72 hrs.This may lead to the insufficiency of pulmonary surfactant synthesis and unstability of pulmonary homeostasis,which contributed to to the pathogenesis of acute lung injury.

Study on the Relationship between TNF-?、NO in the Lung and Pulmonary Artery Pressure in Immature Rabbits with Meconium Aspiration / 中华围产医学杂志

Objective To study the changes of TNF-??NO in lung of immature rabbits with meconium aspiration and the relationship with right ventricular pressure. Methods (1)We established mild and severe immature rabbits model of meconium aspiration by endotracheal intubation imbuing meconium 0.6 ml/kg and 4 ml/kg. (2)We measured the right ventricular pressure by right ventricular puncture. (3)level of TNF-? in lung was measured by radioimmunoassay and that of NO was detected by Cr deoxidation. Results Meconium caused pulmonary inflammatory response which was reflected in the increase of cell counts in BALF, peaking at 24 h after instillation [WBC counts (6.06? 0.15 ) ?10 8/L,PMN counts (0.484?0.009)?10 8/L] and recovered by 72 h[(1.93?0.08)?10 8/L,(0 082?0 007)?10 8]. (2)The level of TNF-? in lung of mild group (1.41?0 15) ng/ml increased significantly comparing with control group (0 48?0.07) ng/ml, level of NO (31.9?2.4) ng/ml decreased significantly. Peaked at 16~24 h and recovered to normal by 72 h. the changes of severe group [TNF-?(1.85?0.17) ng/ml, NO(26.4?2.4) ng/ml] were significantly different from those in mild group. (3) At mild group,the right ventricular pressure began to increase at 16 h ( 19.28 ? 0.10 ) mm Hg, peaked at 24 h (26.78?0.14) mm Hg and returned to normal level by 72 h ( 14.18 ? 0.04) mm Hg. The pressure of severe group ( 32.70 ? 0.14 ) mm Hg was significantly higher than that of control and mild group. Conclusions (1)After immature rabbits aspirating meconium, there were remarkable pulmonary inflammatory responses. (2)The level of TNF-? in lung increased, and was correlated with right ventricular pressure,which revealed that MAS with PPHN could be associated with inflammatory response. (3)The level of NO decreased after meconium aspiration, and was lower at severe group. The level of NO was negatively correlated with right ventricular pressure, which indicated that the severe meconium aspiration was companied with severe damage of endotheliocyte which promoted and exacerbated PPHN.