Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China / 中华儿科杂志

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34+0 weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.

Peripherally inserted central venous catheter-related thrombosis in a neonate / 中国当代儿科杂志

The female infant in this case study was admitted to the hospital 4 hours after birth due to preterm birth and respiratory distress. On the third day after birth, peripherally inserted central venous catheter (PICC) catheterization was performed. On day 42, thrombus was found at the entrance of the right atrium from the inferior vena cava during a cardiac ultrasound, and it was considered to be related to PICC placement. Low-molecular-weight heparin and urokinase were given. After two weeks of treatment, ultrasonic monitoring showed thrombus shrinkage. No bleeding or pulmonary embolism occurred during the treatment. The patient discharged after improvement. This article mainly introduces a multidisciplinary team approach to diagnosis and treatment of PICC-related thrombosis in neonates.

Analysis of association of economic burden of hypertension with tobacco exposure in Luoping county of Yunnan province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the association between hypertension and tobacco exposure Luoping county of Yunnan province and estimate the direct cost attributable to hypertension .</p><p><b>METHODS</b>Using Probability proportional to size (PPS) sampling method, 5000 rural residents aged over 18 years were selected from 12 townships in Luoping county, Yunnan province in April 2011, from which 4611 subjects completed the survey. Self-designed questionnaires were used to collect general information, smoking status, costs for outpatient consultation, inpatient, treatment, medication, travel, accommodation and extra-nutrition caused by hypertension as well as the information of health-related behavior. Their height, weight, waist circumference, hip circumference and blood pressure were measured. The direct economic burden of hypertension was calculated. Chi-square (χ(2)) test was used to compare gender differences of hypertension prevalence, smoking and passive smoking. And t test was used to compare the differences of direct economic burden of hypertension among different gender, smoking and passive smoking status. Multivariable logistic regression model was used to analyze the influence factors of hypertension.</p><p><b>RESULTS</b>Among the 4611 subjects, the age was (46.90 ± 16.74) years old. Male accounted for 49.8% (2294/4611) and female 50.2% (2317/4611) . The smoking rate was higher in males (75.7% (1736/2294)) than in females(1.6% (38/2317)) (χ(2) = 2669.21, P < 0.01). The passive smoking rate was lower in males (10.0% (230/2294)) than in females (46.2% (1070/2317)) (χ(2) = 744.27, P < 0.05). Non-tobacco exposure rate in males (14.3% (328/1537)) was lower than in females (52.2% (1209/1537)) (χ(2) = 744.37, P < 0.05) . The risk of hypertension in smokers and passive smokers were higher than those without tobacco exposure, OR (95%CI) was 1.41 (1.15-1.71) (P < 0.05) and 1.31 (1.07-1.63) (P < 0.05) respectively. The per capita direct cost of hypertension was (3444.09 ± 3067.83) Yuan. Of this, tobacco exposure (4552.46 ± 3189.05) Yuan was higher than non-tobacco exposure (1907.71 ± 1383.94) Yuan (t = -3.81, P < 0.05) . Moreover, smokers were (6951.71 ± 3422.87) Yuan higher than passive smokers (3128.09 ± 2083.17) Yuan (t = 3.19, P < 0.05) and males (5827.39 ± 3240.50) Yuan were higher than females (2633.03 ± 2569.01) Yuan (t = 3.22, P < 0.05) . The total direct costs of hypertension attributable to smoking and SHS was 41 million and 38 million, respectively.</p><p><b>CONCLUSION</b>Both smoking and SHS had significant impact on prevalence and economic burden of hypertension in Luoping county. Implementing effective strategies to control tobacco exposure is useful to reduce the economic burden of hypertension in the study region.</p>

Clinical comparison of transthoracic echocardiography with angiography guided transcatheter occlusion in patent ductus arteriosus / 中华实用儿科临床杂志

Objective To investigate the feasibihty and superiority of transthoracic echocardiography(TTE)guided transcatheter occlusion for patent ductus arteriosus (PDA).Methods Totally 58 patients with simple funnel shape(Type A) PDA were studied retrospectively,and they were divided into angiography group(n =21) and echocardiography group(n =37).The angiography group received traditional transcatheter occlusion technique,and the echocardiography group received TTE guided transcatheter occlusion of PDA.An observation for the effect was taken post operatively,as well as for the comparison between the 2 groups in the aspects of the operation duration,the time of X-ray exposure,the radiation dose,the length of hospital stay and the expense of medication.Results Successful occlusion was performed in all patients.Both of the TTE and angiogram group showed good position of the occlusion devices.Moreover,the velocities of blood flow in left pulmonary artery and the descending aorta were in a normal range.Compared with angiography group,echocardiography group experienced shorter operation duration (P ＜ 0.05),shorter X-ray exposure time (P ＜ 0.05),lower radiation dose,fewer days of hospital stay (P ＜ 0.05) and less expense of the medication (P ＜ 0.05).Conclusions TTE-guided transcatheter occlusion for simple funnel shape PDA (Type A) is a simplified occlusion method,which is effective and preferential treatment to the method of traditional angiography guidance in clinical trials.

Effects of noninvasive limb ischemic preconditioning on anti-stress ability in mice / 中国应用生理学杂志

<p><b>AIM</b>To explore the effects of noninvasive limb ischemic preconditioning on the anti-stress ability in mice.</p><p><b>METHODS</b>Mice were divided into: normal group, control group, preconditioning group and drug group. Hypoxia tolerance test, swimming with weight loading, cold tolerance test and thermostable test were performed, and tolerance time in all the stringent state were observed. SOD activity of serum in hypoxia tolerance test and lactic acid of serum in swimming with weight loading test were determined.</p><p><b>RESULTS</b>The time of hypoxia tolerance in preconditioning group was markedly increased, and SOD activity of preconditioning group mice was significantly higher than those of control group, while they were both shorter than drug group. The average time of swimming in preconditioning group was markedly increased and the level of increasing the swimming time of preconditioning was the same as caffeine. Preconditioning could increase the survival time on high temperature markedly, and there was no significantly difference in the level of increasing the survival time between preconditioning group and chlorpromazine group. Preconditioning could increase the time of cold tolerance markedly compared with normal group.</p><p><b>CONCLUSION</b>Noninvasive limb ischemic preconditioning can improve the ability of anti-hypoxia, anti-fatigue, thermoresistance and cold-resistance in mice.</p>

Lipopolysaccharide induces apoptosis of cytotrophoblasts by activating an innate immune reaction in vitro / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Enhanced apoptosis of cytotrophoblasts in early pregnancy is associated with high risk of intrauterine growth retardation and preeclampsia, which are two common pregnant complications. Its etiological factors remain unclear. Cytotrophoblasts share some traits with innate immune cells and may show response to lipopolysaccharide. This study was conducted to demonstrate whether lipopolysaccharide has apoptosis-inducing effects on cytotrophoblast and the role of innate immune reaction in this process.</p><p><b>METHODS</b>Cytotrophoblasts were isolated from early pregnant villous tissues and cultured with serum-free medium. Subsequently, cytotrophoblasts were treated with lipopolysaccharide at the concentrations of 0 (control), 25, 50, 100 and 200 ng/ml for 24 hours. Apoptosis of cytotrophoblasts was determined by light microscopy, Hoechst 33258 DNA staining with a fluorescent microscope, transmission electron microscope and annexin V-fluorescein isothiocyanate-conjugated/propidium iodide (PI) staining with flow cytometry. Then expression of caspase-3 was detected by Western blot. Confocal immunofluorescence technique was used to detect tumor necrosis factor alpha expression in cytotrophoblasts. The levels of tumor necrosis factor alpha in the culture medium were detected by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>Under light, fluorescence microscope and transmission electron microscope, characteristic alternations of apoptosis in cytotrophoblasts were observed after lipopolysaccharide treatment. Flow cytometry results showed that lipopolysaccharide significantly increased apoptosis indexes of cytotrophoblasts. Significant statistical differences were found in the above groups (P = 0.01). The mean relative densities of bands corresponding to caspase-3 were significantly increased in groups treated with lipopolysaccharide, as compared with the normal control (P < 0.001). Tumor necrosis factor a expression was found to increase in cytotrophoblasts by confocal immunofluorescence technique and in culture medium by enzyme-linked immunosorbent assay after lipopolysaccharide treatment. A positive correlation was found between tumor necrosis factor a expression and apoptosis indexes of cytotrophoblasts (r = 0.747, P < 0.001).</p><p><b>CONCLUSION</b>Apoptosis of cytotrophoblasts could be induced by lipopolysaccharide, in which innate immune reaction is the important mechanism.</p>

Preparation of metal chelate affinity chromatographic medium and its application in the purification of 6 x histidine-tagged protein / 生物工程学报

Using Sepharose CL-6B as support, 3-Chloro-1, 2-epoxypropane as activated agent, carboxymethylated aspartate (CM-Asp) as chelating ligand, A chelate affinity chromatographic medium based on Co2+, named Co-CM-Asp-Sepharose, was prepared and used to purify 6 x His-tagged fusion proteins. The amount of Co-CM-Asp-Sepharose reacted with 200 microL of lysate, the incubation time, wash condition and the imidazole concentration in the elution buffer were optimized. The purification results using Co-CM-Asp-Sepharose and Ni-NTA-Agarose (product of Qiagen) were compared. The CD155D1 fusion protein was also purified from 5mL of lysate and the amount of protein was determined by Bradford method. The results show that 60 microL of Co-CM-Asp-Sepharose (50% suspension) was suitable for the protein purification from 200 microL of lysate, the optimal incubation time of medium and lysate was 30 min, the optimal imidazole concentration in the eluting buffer was 200 mmol/L, and 200 microg of fusion protein was obtained. In a big scale experiment, 4.6 mg of fusion protein was obtained from 5 mL of lysate using 1.5 mL of Co-CM-Asp-Sepharose (50% suspension). Compared with Ni-NTA-Agarose, the Co-CM-Asp-Sepharose medium exhibits higher selectivity and the protein possesses higher purity.

A predictive analysis of the nonsurvivable patients with severe cerebral infarction after mechanical ventilation / 中国脑血管病杂志

Objective: To explore the predictors of the non-survivable patients with severe cerebral infarction after mechanical ventilation. Methods: The clinical data of 36 patients with acute cerebral infarction who had tracheal intubation were analyzed retrospectively. The patients were divided into survivor (n = 18) group and non-survivor group (n = 18) according to their prognosis. The observational endpoint was at day 60. Patients' Glasgow Coma Scale (GCS) score, respiratory function (blood gas pH value, oxygen partial pressure, carbon dioxide partial pressure, and oxygenation index), and the causes of death before tracheal intubation were documented. Results: The mortality at day 60 after mechanical ventilation was 50% in patients with severe cerebral infarction. The median GCS score was 3. 6 ± 1. 0 in the non-survivor group, and the median GCS score was 6.3 ± 1.2 in the survivor group before tracheal intubation. Oxygen partial pressure and oxygenation index presented to decrease in both groups before the tracheal intubation. The median oxygen partial pressure in the survivor and non-survivor groups were 69 ± 17 and 52 ± 7 mm Hg, respectively; and the oxygenation indexes were 170 ± 31 and 109 ± 34, respectively. The univariate analysis showed that the patients' GCS scores decreased before the tracheal intubation. The decrease of oxygen partial pressure and oxygenation index were the important factors for predicting mortality. The multivariate regression analysis showed that the patients' GCS score (P = 0.015) and oxygen partial pressure (P = 0.026) before the tracheal intubation were an independent factors for predicting the mortality in patients with cerebral infarction at day 60 after the mechanical ventilation. Conclusion: For patients with severe cerebral infarction, the mechanical ventilation support may contribute to decreasing the mortality, particularly in patients whose respiratory system complications have resulted in deterioration of the disease. The aggregate analysis has showed that the patients' severity of conscious disturbance and the oxygenation parameters before the tracheal intubation may contribute to predicting the prognosis.

Relationship between the level of serum E-selectin and SER128ARG polymorphisms of E-selectin in patients with acute myocardial infarction / 中华急诊医学杂志

Objective To explore the relationship between the serum level of E-selectin and S128R polymorphisms in the exon 4 of E-selectin gene and acute myocardial infarction (AMI) in local Han peoples. Method The genotype of E-selectin were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 168 patients with acute myocardial infarction and 200 healthy controls,and the serum level of E-selectin was measured by enzyme-linked immunosorbent assay (ELISA).Results There was significant difference in frequencies of allele and genotype in S128R polymorphism between acute myocardial infarction and control groups respectively,The relative risk suffered from acute myocardial infarction of SS genotype was 2.234 times of the SR genotype (OR=2.234,95% CI:1.112～4.437),The serum E-selectin level was significantly higher among carriers of SR genotype as compared with SS genotype (41.65?8.87)?g/L vs (34.23?6.72)?g/L,P

Effect of peroxisome proliferators-activated receptor ? ligands on cytotrophoblast invasion in first trimester pregnancy / 中华妇产科杂志

Objective To investigate the expression of peroxisome proliferators-activated receptor ? (PPAR?) in trophoblast and relation between PPAR? ligands and trophoblast invasion.Methods We examined the expression of PPAR? by immunohistochemistry,immunocytochemistry and real time quantitative PCR.We next examined,using the cytotrophoblast culture model,the biological role of PPAR? ligands in vitro.Results PPAR? was mainly localized in the nuclei of villous cytotrophoblast and extravillous cytotrophoblast of cell islands and cell columns.In villous tissue and cultured trophoblast from early first trimester,the level of expression of PPAR? mRNA and protein was 36.0?5.1,13.4?3.1 and 1.35?0.08,1.13?0.11;from late first trimester it was 23.3?5.5,6.1?1.3 and 1.17?0.03,0.86 ?0.05,and the expression of PPAR? was obviously decreased (P