Risk factors for metabolic bone disease of prematurity in very/extremely low birth weight infants: a multicenter investigation in China / 中国当代儿科杂志

OBJECTIVE@#To investigate the incidence rate and risk factors for metabolic bone disease of prematurity (MBDP) in very low birth weight/extremely low birth weight (VLBW/ELBW) infants.@*METHODS@#The medical data of 61 786 neonates from multiple centers of China between September 1, 2013 and August 31, 2016 were retrospectively investigated, including 504 VLBW/ELBW preterm infants who met the inclusion criteria. Among the 504 infants, 108 infants diagnosed with MBDP were enrolled as the MBDP group and the remaining 396 infants were enrolled as the non-MBDP group. The two groups were compared in terms of general information of mothers and preterm infants, major diseases during hospitalization, nutritional support strategies, and other treatment conditions. The multivariate logistic regression analysis was used to investigate the risk factors for MBDP.@*RESULTS@#The incidence rate of MBDP was 19.4% (88/452) in VLBW preterm infants and 38.5% (20/52) in ELBW preterm infants. The incidence rate of MBDP was 21.7% in preterm infants with a gestational age of < 32 weeks and 45.5% in those with a gestational age of < 28 weeks. The univariate analysis showed that compared with the non-MBDP group, the MBDP group had significantly lower gestational age and birth weight, a significantly longer length of hospital stay, and a significantly higher incidence rate of extrauterine growth retardation (@*CONCLUSIONS@#A lower gestational age, hypocalcemia, extrauterine growth retardation at discharge, and neonatal sepsis may be associated an increased risk of MBDP in VLBW/ELBW preterm infants. It is necessary to strengthen perinatal healthcare, avoid premature delivery, improve the awareness of the prevention and treatment of MBDP among neonatal pediatricians, and adopt positive and reasonable nutrition strategies and comprehensive management measures for preterm infants.

Effect of Comprehensive Protocol of Integrative Medicine on Motor Function, Activity of Daily Living and Quality of Life in Hemiplegia Patients after Stroke / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the effects of integrative medicine (IM) rehabilitation protocolon motor function, activity of daily living, and quality of life (QOL) in hemiplegia patients after stroke.</p><p><b>METHODS</b>Totally 120 patients with post-stroke hemiplegia were allocated to four groups using sealed envalope drawing, i.e., the rehabilitation group, the Chinese medical treatment group, the acupuncture group, and the comprehensive rehabilitation group, 30 cases in each group. Based on routine rehabilitative training, patients in the Chinese medical treatment group, the acupuncture group, and the compre-hensive rehabilitation group received standardized treatment based on syndrome typing, Shi's Consciousness-Restoring Resuscitation acupuncture, Chinese herbs + acupuncture comprehensive rehabilitatino protocol, respectively. The treatmet cycle consisted of 4 weeks with 24-week follow-ups. Fugl-Meyer motor assessment (FMA), Modified Barthel Index (MBI), and Stroke-Specific Quality of Life Scale(SS-QQL), and safety assessment were taken as main effect indices before treatment, at week 4 of treatment, at week 12 and 24 of follow-ups, respectively.</p><p><b>RESULTS</b>There was no statistical difference in FMA score, MBI score, SS-QOL score among the four groups before treatment (P > 0.05). These scores were significantly improved in the four groups at week 4 of treatment, week 12 and 24 of follow-ups, respectively (P < 0.05). Besides, FMA score and SS-QOL score were significantly improved in the comprehensive rehabilitation group at each corresponding time point, as compared with other treatment groups (P < 0.05).</p><p><b>CONCLUSIONS</b>The comprehensive protocol could significantly improve motor function, activity of daily living in hemiplegia patients after stroke, and further improve their QOL. Its effect was better than other single treatment.</p>

Relationship between serum adiponectin and bone mineral density in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine serum adiponectin level in preterm infants and to evaluate the relationship between serum adiponectin and bone mineral density in preterm infants.</p><p><b>METHODS</b>Seventy-two appropriate-for-gestational-age neonates were classified into three groups according to their gestational ages: early preterm (31-33(+6) weeks, 13 cases), late preterm (34-36(+6) weeks, 16 cases), and full-term (37-42 weeks, 43 cases). Venous blood was collected at one week of their life to measure serum adiponectin concentration. During the period, omnisense ultrasound bone sonometer was applied to measure speed of sound (SOS) of the left tibia.</p><p><b>RESULTS</b>The median of tibia SOS in the early preterm group was significantly lower than in the late preterm and full term groups (P<0.05), and the median of tibia SOS in the late preterm group was lower than in the full-term group (P<0.05). Serum adiponectin level was lowest in the early preterm group, and the full-term group had the highest serum adiponectin level. Serum adiponectin level was positively correlated with tibia SOS in preterm infants (r=0.664, P<0.05). According to the result of multivariate linear stepwise regression analysis, serum adiponectin and birth weight were independent predictor of tibia SOS in preterm infants.</p><p><b>CONCLUSIONS</b>Serum adiponectin level is lower in preterm infants than that in full-term infants. There is a positive correlation between serum adiponectin and bone mineral density in preterm infants.</p>

Relationship between bone turnover markers and bone sound of speed in appropriate-for-gestational-age neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the correlation of gestational age (GA) with carboxyterminal propeptide of type I procollagen (PICP), deoxypyridinoline (DPD), and bone sound of speed (SOS) in appropriate-for-gestational-age (AGA) neonates, as well as the relationship between bone turnover markers and bone SOS.</p><p><b>METHODS</b>Sixty-five AGA neonates were included in the study. The neonates were divided into three groups: preterm infant (GA ≤3 4 weeks, 14 cases), late preterm infant (34 weeks<GA<37 weeks, 13 cases), and full-term infant (GA ≥ 37 weeks, 38 cases). Birth weight and length were measured in all cases, and Ponderal index (PI) was used to estimate their nutritional status. Venous blood was collected within 7 days after birth to measure blood PICP concentration. Urine was collected to measure urinary DPD and creatinine (Cr) levels. Omnisense 7000P ultrasound bone sonometer was applied to measure the SOS of the left tibia in all cases within 7 days after birth.</p><p><b>RESULTS</b>There were significant differences in GA (F=140.199, P<0.001), birth weight (F=47.042, P<0.001), birth length (F=46.877, P<0.001), and PI (F=11.898, P<0.001) between the three groups; the higher the GA, the higher the birth weigh, birth length, and PI. There were significant differences in PICP (F=30.384, P<0.001), DPD/Cr (F=21.761, P<0.001), and SOS (F=20.052, P<0.001) between the three groups; the higher the GA, the lower the PICP and DPD/Cr and the higher the bone SOS. PICP and DPD/Cr were negatively correlated with GA, birth weight and bone SOS (P<0.01), while bone SOS was positively correlated with GA and birth weight (P<0.01), which still held true after adjustment for GA and birth weight.</p><p><b>CONCLUSIONS</b>Among AGA neonates, bone turnover markers are negatively correlated with GA, birth weight and bone SOS. High bone turnover is bad for bone health in AGA neonates.</p>

Effects of L-Arg on expression of PI3K and PKB in liver among low-birth-weight newborn rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To measure the expression of phosphatidylinositol 3-kinase (PI3K) and protein kinase B (PKB) in liver tissue among low-birth-weight newborn rats treated with L-arginine (L-Arg) in early life, and to investigate the effect of L-Arg on insulin resistance.</p><p><b>METHODS</b>Eighteen pregnant rats were randomly divided into three groups: control, model and intervention (n=6 each). The control group was fed with normal protein feed (protein content=21%) during pregnancy to establish a normal-birth-weight newborn rat model, and the model and intervention groups were fed with low-protein feed (protein content=10%) during pregnancy to establish a low-birth-weight newborn rat model. Newborn rats from the three pregnant rat groups were also assigned to control, model and intervention groups. During 21 days of lactation, maternal rats in the control and model groups were fed with normal protein feed and normal drinking water, while maternal rats in the intervention group were fed with normal protein feed and drinking water rich in L-Arg (200 mg/kg·d). After ablactation, the three groups of newborn rats were fed with normal protein feed and normal drinking water. Liver tissue samples were collected from these newborn rats at 1, 3 and 8 weeks after birth. Protein expression of PI3K and PKB in liver tissue was measured by Western blot.</p><p><b>RESULTS</b>At 1 week after birth, the newborn rats in the intervention group had significantly higher protein expression of PI3K than in the model group (P=0.045), but there was no significant difference when compared with the control group (P=0.503). At 8 weeks after birth, the newborn rats in the intervention group had significantly higher protein expression of PKB than the model group (P=0.039), but there was no significant difference when compared with the control group (P>0.05).</p><p><b>CONCLUSIONS</b>A supplement of L-Arg in early life can boost protein synthesis, increase protein expression of PI3K and PKB in liver tissue, promote insulin signaling and reduce insulin resistance.</p>