Effect of conventional treatment plus long-term transcranial direct current stimulation on consciousness recovery of minimally conscious patients after traumatic brain injury / 中华创伤杂志

Objective:To investigate the effect of conventional treatment plus long-term transcranial direct current stimulation (tDCS) on consciousness recovery in patients with minimally conscious state (MCS) after traumatic brain injury (TBI).Methods:A retrospective cohort study was conducted to analyze the clinical data of 60 patients with MCS after TBI admitted to Zhejiang Armed Police Corps Hospital from January 2019 to December 2020, including 38 males and 22 females, aged 19-60 years [(45.7±11.4)years]. Course of disease was 3-6 months [(4.6±0.9)months]. Of all, 30 patients received internal medicine, hyperbaric oxygen, rehabilitation and other conventional treatment (conventional treatment group), and 30 patients received tDCS stimulation on the basis of conventional treatment (tDCS treatment group). The tDCS stimulation contained 4 cycles for 28 days with each cycle lasting for 7 days (stimulation for 5 days, rest for 2 days). Coma recovery scale-revised (CRS-R) total score, brainstem auditory evoked potential (BAEP) score and clinical effictive rate (significantly effective+effective) were compared between the two groups before treatment, during 4 cycles of treatment and at 6 months and 12 months after treatment. Complications induced by tDCS were also evaluated.Results:There was no significant difference in CRS-R total score and BAEP score between the two groups before treatment (all P>0.05). CRS-R total score and BAEP score in tDCS treatment group were significantly higher than those in conventional treatment group during 4 cycles of treatment and at 6 months and 12 months after treatment (all P<0.05). CRS-R total score and BAEP score in both groups gradually increased during 4 cycles of treatment and at 6 months and 12 months after treatment (all P<0.05). The clinical effective rate in tDCS treatment group was 73% (22/30) when compared to 57% (17/30) in conventional treatment group ( P<0.05). In tDCS treatment group, 10 patients had local reversible slight redness at the cathodal position, while no other serious adverse effects, such as local burns, ulceration, exudation or epilepsy. Conclusion:Compared with conventional treatment, conventional treatment plus long-term tDCS can be more effective in improving the state of consciousness without serious adverse effects for MCS patients after TBI.

Clinical study of inter-hospital transport of 237 neonates with acute and critical congenital heart disease / 中华实用儿科临床杂志

Objective:To investigate the safety of inter-hospital referral and the prognosis of neonatal with critical congenital heart disease.Methods:The criticality score, transit distance and time, and the prognosis of 237 newborns with critical congenital heart disease in Guangdong Provincial People′s Hospital from July 2016 to July 2018 were retrospectively analyzed.Results:A total of 237 children were included (162 male and 75 female) with the median age of 6 days and the median body weight of 2.98 kg.The median transit distance was 90 km.The average value of neonatal critical illness score (NCIS) was (86.54±9.05) scores before transport; 136 cases were greater than 90 scores, 84 cases between 70 and 90 scores, 17 cases less than 70 scores; while the average NCIS was (87.05±8.19) scores when arrived at neonatal intensive care unit (NICU), 138 cases were greater than 90 scores, 82 cases between 70 and 90 scores, 17 cases less than 70 scores.There were no significant differences in the scores of critical cases before and after transfer according to the transfer time and distance ( t=0.346, P>0.05). There was no one death occurred during the transfer process.All over, 222 cases were cured and discharged from the hospital after surgery and or medical interventional treatments, 15 cases died after giving up treatment or losing the opportunity for surgery. Conclusions:It is safe and effective of the inter-hospital transport for the rescue of infants with critical congenital heart disease when followed the principles and transport rules and regulations, with trained workers and special equipments.

Time for spontaneous closure of ductus arteriosus and dynamic changes with cardiac index,peripheral vascular resistance,blood pressure of different gestational age neonates / 中华实用儿科临床杂志

Objective To investigate the time for spontaneous closure of the ductus arteriosus and the trends of cardiac index(CI),peripheral vascular resistance index(SVRI)and blood pressure of neonates with different gesta-tional ages(GA). Methods A prospective observational study about 95 newborns,including 20 full - term and 75 pre-term infants were divided into 4 groups according to their GA as GA ﹤ 32 weeks(n = 27),32 weeks≤GA ﹤ 34 weeks (n = 25),34 weeks≤GA ﹤ 37 weeks(n = 23),GA≥37 weeks(n = 20). Patent ductus arteriosus was diagnosed by echocardiography(ECHO)at the time of 24 h,48 h,72 h,7 d and 14 d. CI,SVRI and blood pressure were measured with ultrasonic cardiac output monitor(USCOM). Results The cumulative spontaneous closure rate of arterious ductus of 32 weeks≤GA ﹤34 weeks,34 weeks≤GA ﹤37 weeks group and GA≥37 weeks group at 24 h after birth was 44. 0% , 61. 0% and 90. 0% respectively. However the rate was only 59. 1% at 72 h with the GA less than 32 weeks,of which 9 cases needed ibuprofen and 1 patient was conducted ductus arteriosus ligation. The differences in cumulative closure rate among 4 groups based on GA at 5 time points were statistically significant(χ2 =6. 756,4. 735,18. 890,11. 366,28. 159,all P ﹤0. 05). There was significant increase of systolic blood pressure,diastolic blood pressure and SVRI with ductus arte-riosus closure(t = -32. 561,-19. 913,-31. 791,4. 760,all P ﹤0. 000 1;t = - 25. 091,- 23. 400,- 21. 147,2. 240,all P ﹤0. 05;t = -10. 931,-9. 975,-9. 629,2. 350,all P ﹤ 0. 05). Whereas CI significantly decreased in groups of GA ﹤32 weeks,32 weeks ≤GA ﹤34 weeks,34 weeks ≤GA ﹤37 weeks(t =9. 224,6. 515,5. 996,all P ﹤ 0. 001)and no sig-nificant changes in GA≥37 weeks(t =0. 940,P ﹥0. 05). Conclusions With the increase of gestational age,the rate of naturally early arterial catheter closure is higher. Whereas there still are nearly one - third infants requiring medical or surgical intervention in the group of GA ﹤32 weeks. Ductus arteriosus has great influence on hemodynamics. For preterm, especially very low birth weight preterm,the use of ECHO and USCOM can early detect and treat patent ductus arteriosus.

Chondrogenic differentiation of bone marrow mesenchymal stem cells / 中国组织工程研究

BACKGROUND: Bone marrow mesenchymal stem cells are important seeded cells for construction of tissue-engineered trachea, but there is no special surface marker. Therefore, identification of bone marrow mesenchymal stem cells is mostly based on morphology, phenotype antigen and the function of differentiation. OBJECTIVE: To explore the feasibility of the tracheal chondrogenic differentiation of bone marrow mesenchymal stem cells under a special condition through isolation, cultivation and identification of bone marrow mesenchymal stem cells. METHODS: Rabbit bone marrow was acquired in the sterile environment to isolate and culture bone marrow mesenchymal stem cells to passage 2 by bone marrow adherence and screening method. Flow cytometry identified the phenotype CD44, CD45 of bone marrow mesenchymal stem cells at passages 1 and 2. Rabbit tracheal samples were acquired in the sterile environment, the tracheal chondrocytes were isolated and cultured by enzyme digestion, and toluidine blue staining was used to detect aggrecan. Bone marrow mesenchymal stem cells were co-cultured with tracheal chondrocytes by Transwel and transforming growth factor β1. Cel morphology was detected under an inverted microscope. Real-time quantitative PCR and toluidine blue staining detected the extracel ular matrix components, such as type Ⅱ col agen and aggrecan.RESULTS AND CONCLUSION: After isolation and culture, cells were spindle and irregular in morphology, and passaged cells thrived that were gathered into a fish-like colony growth. For passage 1 bone marrow mesenchymal stem cells, the positive rates of phenotype antigen CD44 and CD45 were respectively 96.97% and 13.72%; for passage 2 cells, the positive rates of phenotype antigen CD44 and CD45 were 99.11% and 8.54%, respectively. Tracheal chondrocytes were positive for toluidine blue staining. The morphology of induced bone marrow mesenchymal stem cells changed from long fusiform to triangular or irregular shape, indicating the chondrocytes expressed type Ⅱ col agen and aggrecan, and toluidine blue staining was positive. These results showed bone marrow adherence and screening method could acquire bone marrow mesenchymal stem cells, and the purity of passage 2 cells is higher. Under a special condition, bone marrow mesenchymal stem cells have the potential of chondrogenic differentiation, and can be selected as seed cells for construction of tissue-engineered trachea.

Advances in application of flexible bronchoscopy in neonatal intensive care unit / 中国小儿急救医学

Flexible bronchoscopy has become an important diagnostic and therapeutic technique in the neonatal intensive care unit.With the improvement of the instrument and operating techniques of the bronchoscopists,flexible bronchoscopy has been applied in the preterm infant that weighted 600 grams.In this article,a review of application of flexible bronchoscopy in neonates,including diagnostic and therapeutic indications,security in the neonatal applications would be presented.

Application of noninvasive hemodynamic monitoring in critically ill children / 国际儿科学杂志

Hemodynamic monitoring is an important means for the assessment of acute and critically ill children, especially for the early detection of circulatory disturbance and guiding targeted treatment. There are a variety of hemodynamic monitoring methods, however, some defects limit their wide application in pediatric patients. In recent years, with the development of color Doppler technology, a new non-invasive hemodynamic monitoring device was launched, which has the advantages such as non-invasive, continuous dynamic monitoring, suitable for bedside use, providing a new choice for hemodynamic monitoring. This review summarized the application of noninvasive hemodynamic monitoring in critically ill children.