Several problems in the diagnosis and treatment of neonatal bacterial meningitis / 中华实用儿科临床杂志

Neonatal bacterial meningitis remains a common and life-threatening disease in newborns, with high mortality and morbidity.Despite its declining incidence in recent years, the rate of severe sequelae shows slight changes.The clinical manifestation of neonatal bacterial meningitis is atypical, and thus its diagnosis requires cerebrospinal fluid examination.Early detection and effective antibiotic treatment are the key to improve the survival rate.In addition, neonatal bacterial meningitis is often complicated with brain edema and intracranial hypertension, which would result in cerebral ischemia and hypoxia, and further aggravate brain injury.Therefore, more attention should be paid to the prevention and treatment of brain edema and intracranial hypertension while adopting antibiotic therapy in the treatment of neonatal bacterial meningitis.

Impact of maternal obesity on fetus and neonate / 中国小儿急救医学

The prevalence of obesity has become one of the most problems that affect human health in 21th Century.The offspring of obese mothers have a higher rate of perinatal morbidity and an increased risk of long-term health problems.Maternal obesity has been associated with high risk of adverse pregnancy outcomes such as stillbirth,congenital malformation of fetus,and an increased rate of cesarean delivery,especially in emergency cesarean section.The notion that an abnormal maternal metabolic environment,through epigenetic modifications,may lead to permanent changes in key organs that underlie fetal/juvenile programming of adult disease,such as obesity,cardiovascular disease,type Ⅱ diabetes and other metabolic syndrome.Therefore,by the weight control of obese gestational age women or the prevention of excessive weight gain during pregnancy,it will significantly decrease the affection of obese mothers on the fetus,reduce the occurrence of adult obesity,diabetes,cardiovascular disease and metabolic syndrome.

Several misunderstandings on PBL teaching / 中华医学教育探索杂志

Problem-based learning (PBL) has been widely used all around the country.But there are still many misconceptions on the understanding of the PBL teaching in the process of teaching practice,which reduces the PBL teaching effect.For example,it is a misunderstanding to put problems to asking for answers to the questions other than solving the problems and to put case-based learning (CBL) and team-based learning (TBL) to PBL.In this paper,we combined the references with the practice experience to compare PBL with CBL,TBL and flipped instruction in both features and connotations based on the brief discussion of the problem in PBL teaching,to further strengthen the understanding of the PBL teaching.It is only the use of clinical cases to guide students to find the defects of the knowledge required for solving the problem and the process of acquiring the scientific knowledge which is implicit in the problem through the students' autonomous learning that can be called as PBL teaching.

The clinical analysis of the factors influencing the therapeutic effect of INSURE technology in premature infants with respiratory distress syndrome / 临床儿科杂志

ObjectiveTo assess the factors inlfuencing the therapeutic effects of INSURE technology in premature in-fants with respiratory distress syndrome (NRDS).MethodsThe clinical data from 309 infants with NRDS treated by INSURE technology were retrospectively analyzed from Jan. 2000 to Dec. 2012.ResultsIn 309 infants with NRDS, 302 infants were cured and the cure rate was 97.7%. Twenty-one infants (6.8%) needed the reintubation for mechanical ventilation within 72 h. The difference in reintubation rate was statistically signiifcant among infants with different gestational age (P<0.01). The infants with the gestation age≤28 weeks had a signiifcantly higher reintubation rate. According to whether the reintubation was performed, the infants were divided into success group and failure group. Compared to the success group, there were higher percentage of infants who had gestation age≤28 weeks, birth weight <1000 g and severe NRDS, needed high dose and repeated use of pulmo-nary surfactant and oxygen therapy, and had higher mortality in the failure group had (allP<0.05).ConclusionsThe INSURE technology can be effective in treatment of NRDS. Small gestational age, low birth weight, and severe NRDS are the risk factors for the failure of the INSURE technology.

Meconium-stained amniotic fluid and nervous system damage / 中华实用儿科临床杂志

For a long time,it was believed that meconium - stained amniotic fluid(MSAF)was caused by fe-tal intrauterine hypoxia induced fetal defecation,once considered synonymous with fetal intrauterine hypoxia. But,MSAF may be a natural phenomenon that mature fetal defecated in intrauterine. Meconium discharge increased and the ability to remove meconium reduced were the important mechanism of the fetal intrauterine distress induced MSAF,when suf-fered from the fetal intrauterine anoxia. MSAF induced damage in the body was associated with the concentration of me-conium,the exposure duration to the meconium amniotic fluid and the causes of meconium discharge. Meconium can di-rectly damage fetal - placental vasculature and promote the release of inflammatory factor,both of them may be involved in the brain injury. The significance of the MSAF and its relationship to brain injury remains for further study.

Clinical analysis of respiratory distress syndrome of infants at term and near term delivered by elective cesarean section / 中华实用儿科临床杂志

Objective To access the incidence,clinical characteristics and the factors affecting therapy of respiratory distress syndrome (RDS) in the infants at term and near term delivered by elective cesarean section.Methods A retrospective cohort study among consecutively admitted infants with RDS at the Neonatal Intensive Care Unit of the Department of Neonatology,Xiangya Hospital,Central South University from Jan.2004 to Dec.2011 were conducted.The inborn infants at 36-42 weeks gestation with RDS,whom were delivered by Elective Cesarean Section from January 1 st,2004 to December 31st,2011 were enrolled.These cases with the timing of elective caesarean section,gestational age,intrauterine infection,asphyxia at birth,which affecting the occurrence of RDS were compared.Results Fifty one infants were entered into the study,which were all met standard of Elective Cesarean Section.Among these infants,33 cases (64.7％,33/51 cases) were delivered by cesarean section without any reason.In these 51 cases,the constituent ratio of elective caesarean section in gestational age ＞ 39 weeks was lower than in gestational age ＞ 36-＜39 weeks,and the difference was significant (31.4％ vs 68.6％,x2 =0.560,P ＜0.01).Asphyxia at birth was the main risk factors of term and near term with RDS (OR =7.306,95％CI:0.018-51.101,P =0.041).Compared to the infants whom born without asphyxia,the infants born with asphyxia usually came out to RDS right after born (x2 =0.080,P ＜ 0.01),required longer time of mechanical ventilation and had significant lower effective ratio (x2 =0.071,8.843,all P ＜ 0.01).Conclusions Asphyxia is the first manifestations of term and near term infants with RDS.These infants often can be onset after birth.

Clinical analysis of an nosocomial outbreak of Klebsiella pneumoniae in neonatal intensive care unit / 临床儿科杂志

Objectives To discuss the clinical characteristic, cause and measures to prevention and control of nosocomial infection in a neonatal intensive care unit (NICU). Methods Retrospectively analyzed an nosocomial infection outbreak of Klebsiella pneumoniae in NICU. Results From Sept. 3, 2010 to Oct. 3, 2010, there were 7 cases of hospital infection in 12 cases of sputum cultured Klebsiella Pneumoniae. The gestational age (GA) of 7 hospital infection cases was 28.5±2.6 week. The birth weight of infection cases was 941.4±309.8 g. The onset of infection was at 31.7±12.8 d of hospitalization. The nosocomial incidence was 2.41%in the hospital, which was 5.79%in preterm infants, 50.00%in GA<28w infants, and 42.86%in extremely low birth weight infant (ELBW). All sputum culture results were displayed as multi-drug resistant of Klebsiella pneumoniae, penicillin and third-generation cephalosporin antibiotic resistance rate of 75%to 100%. The resistance rates to penicillin and cephem antibiotics were 75% -100%, carbapenems was 58.3%, piperacillin/tazobactam was 25.0%. All nosocomial patients were cured. Conclusions GA<28w and ELBW infants are at increased risk of nosocomial infection in NICU. The emergence of carbapenems resistant Klebsiella Pneumoniae has been increasing with the widespread use of carbapenems. Hospital infection can be controlled by standardized medical behavior, which can decline the nosocomial infection incidence and mortality of preterm infants in NICU.

Protective effect of NMDA receptor antagonist memantine on acute lung injury in mice / 中南大学学报(医学版)

OBJECTIVE@#To investigate the protective effect of a non-specific NMDA receptor antagonist memantine on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice.@*METHODS@#Healthy male mice were divided into 4 groups: a normal group, a memantine group, an ALI group and a memantine+ALI group. The ALI group was induced by intraperitoneal injection of LPS (10 mg/kg). Memantine (10 mg/kg) was injected intraperitoneally before the injection of LPS to determine the effect of blockade of NMDA receptor in the memantine+ALI group. The lung wet/dry ratio was detected. HE staining was preformed to show the morphological changes in the lung tissue. Myeloperoxidase enzyme (MPO) activity and malondialdehyde (MDA) content in the lung tissue were detected. ELISA was used to detect the tumor necrosis factor-α (TNF-α) content and lactate dehydrogenase (LDH) activity in the bronchoalveolar lavage fluid (BALF).@*RESULTS@#Memantine pretreatment improved the LPS-induced ALI lung tissue morphological changes, reduced their lung wet/dry ratio, the levels of TNF-α and LDH activity in BALF, and also reduced the MPO and MDA content in the lung tissue.@*CONCLUSION@#Blockade of NMDA receptors can ameliorate LPS-induced mice ALI.

Influence of intrauterine hypoxia on the lung blood vessel development in rats after birth and expression of VEGF in the lung / 中南大学学报(医学版)

OBJECTIVE@#To observe the effect of intrauterine hypoxia on the development of rat lung after birth under ordinary pressure and normoxia, on the expression of vascular endothelial growth factor (VEGF) in the lung as the age increasing after birth, and to provide experimental basis for the treatment of intrauterine hypoxia after baby was born.@*METHODS@#Intrauterine hypoxia models were established. The rats were divided into an air-control group (the control group) and a hypoxic 6-day group (the hypoxic group). All rats were fed under normal pressure and normoxia after they were born. At postnatal 7, 14, and 21 days, we measured the pulmonary vascular morphometry, detected the expression of VEGF protein with immunohistochemisty, the expression of VEGF mRNA with real-time PCR, and observed the alteration of capillary endothelium in the lung tissues under the electron microscope.@*RESULTS@#The expression of VEGF protein and VEGF mRNA in the 2 groups increased as the rats grew, but the expression increased slower in the hypoxic group than that in the control group. The increase curve of the 2 groups crossed. There was no significant difference between the 2 groups in the pulmonary vascular morphometry at each experiment time point. Hyperplasia of capillary endothelium decreased with age. Cellular edema of capillary endothelium was obvious especially at the 14th day after birth under the electron microscope.@*CONCLUSION@#The expression of VEGF protein and VEGF mRNA has slower increase in the intrauterine hypoxic rats than that in the normal control rats. The expression of VEGF may influence the development of lung vessel after rats was born.

Acceleration transition from‘undergraduate' to‘postgraduate' for eight-year-program medical students / 中华医学教育探索杂志

Eight-year-program medical students would be officially into 'postgraduate' stage when they complete the study task of 'undergraduate'.Eight-year-program medical students should do the following four aspects to promote the transition from 'undergraduate' to ' postgraduate'.First,changing the study manner from inactive to active and fostering independent learning ability; second,strengthening the communication skills with different people; third,cultivating clinical thinking and taking advantages of various basic knowledge; fourth,emphasizing the training of scientific research thinking ability.