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.

Clinical features of 23 neonates infected with Omicron variant of severe acute respiratory syndrome coronavirus 2 / 中国当代儿科杂志

OBJECTIVES@#To summarize the clinical features of neonates infected with Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).@*METHODS@#The medical data of 23 neonates with Omicron variant of SARS-CoV-2 infection admitted to the City North Campus of Urumqi First People's Hospital from October to December 2022 were retrospectively reviewed.@*RESULTS@#All 23 infants had a history of exposure to confirmed caregivers with SARS-CoV-2 infection after birth, and none of them was vertically transmitted. Clinical classification: 5 cases of asymptomatic infection, 18 cases of mild infection, and no cases of moderate, severe, or critically ill. The first symptoms were fever in 13 cases, cough in 3 cases, nasal congestion in 1 case, and diarrhea in 1 case. Blood white blood cell counts decreased in 2 cases, and C-reactive protein increased in 1 case. Seven infants underwent chest X-ray examination due to cough or shortness of breath, and one of which showed focal exudative changes, while the rest showed no abnormal changes. All infants were discharged after symptomatic treatment and the median hospital stay was 6 days. The duration of nucleic acid positivity of SARS-CoV-2 was negatively correlated with N gene Ct values and ORF1ab gene Ct values (rs=-0.719 and -0.699, respectively; P<0.05). One month after discharge, all infants had no symptoms or signs of nucleic acid re-positivity.@*CONCLUSIONS@#The clinical manifestations are usually mild or asymptomatic in neonates infected with SARS-CoV-2 Omicron variant. The lower the Ct values of the N and ORF1ab genes of SARS-CoV-2, the longer the duration of nucleic acid positivity. Neonates infected with SARS-CoV-2 Omicron variant can have a good prognosis after symptomatic treatment.

Protective effect and mechanism of p-hydroxybenzaldehyde on blood-brain barrier / 中国中药杂志

The disruption of blood-brain barrier(BBB) induced by oxidative stress is an important pathological reaction which results in secondary brain injury during the cerebral ischemia-reperfusion. This study was designed to investigate the protective effect and mechanism of p-hydroxybenzaldehyde (p-HBA) from Gastrodia elata on BBB. The BBB is mainly consisted of vascular endothelial cells and astrocytes, so brain microvascular endothelial cell line (bEnd.3) and astrocytes (Ast) in mice were used in this study to establish BBB model. H₂O₂-induced oxidative stress was employed to induct the BBB damage. The bEnd.3 cells or astrocytes were exposed to different concentrations of H₂O₂ (0.125, 0.25, 0.5, 0.75 mmol·L⁻¹) for 4 h, then exposed to 0.5 mmol·L⁻¹ H₂O₂ for different duration (1, 2, 4, 6 h) to detect the reasonable condition of oxidative injury. After intervention by different concentrations of p-HBA(12.5, 25, and 50 mg·L⁻¹), LDH leakage rate was detected for bEnd.3 and Ast cells; the expression levels of tight junction protein claudin-5 and occludin in bEnd.3 cells were determined by Western blot and immunofluorescence. Nrf2, HO-1 and NQO1 in normal bEnd.3 cells and astrocytes as well as H₂O₂-induced damaged in astrocytes were detected by western blot after treatment with p-HBA. The results showed that the optimal condition of H₂O₂ induced damage in bEnd.3 cells and astrocytes was set up as exposure the cells to 0.5 mmol·L⁻¹ H₂O₂ for 4 h. Different concentrations of p-HBA could decrease LDH leakage rate after bEnd.3 and Ast injury was induced by H₂O₂; increase the protein expression levels of claudin-5, occludin, Nrf2, HO-1 and NQO1; and increase the expression levels of Nrf2, HO-1 and NQO1 in normal and H₂O₂-induced damaged astrocytes. These findings indicate that the p-HBA has protective effect on the BBB, and the related mechanism seems to involve up-regulating tight junction protein of the bEnd.3 cells and enhancing endogenous antioxidant capacity by activating the Nrf2/ARE pathway in both of bEnd.3 cells and astrocytes.

Recent advances in the study of mechanism of APOBEC3G against virus / 药学学报

APOBEC3 is a class of cytidine deaminase, which is considered as a new member of the innate immune system, and APOBEC3G belongs to this family. The research about APOBEC3G is a new direction of innate immune defense mechanism against virus. APOBEC3G has the restrictive activity on many viral replications, which deaminates dC to dU in the viral genome and then induces extensive hypermutation. APOBEC3G can also interrupt viral replication at several phases such as reverse transcription, replication, nucleocapsid and so on by non-deamination mechanisms. However, virus can encode viral proteins to counteract the restriction activity of APOBEC3G. Elucidation of the antagonistic interaction between APOBEC3G and the virus will be contributed to development of new antiviral drugs in the future.

Relationship between programmed death-ligand 1 and clinicopathological characteristics in non-small cell lung cancer patients / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the correlation between programmed death-ligand 1 (PD-L1) expression in primary lung cancer cells, tumor associated macrophages (TAM) and patients' clinicopathological characteristics.</p><p><b>METHODS</b>From 2008 to 2010, 208 non-small cell lung cancer patients who underwent surgery or CT-guided biopsy were recruited from Huadong Hospital, Fudan University. Immunohistochemistry staining was performed to evaluate the PD-L1 expression in both primary lung cancer cells and CD68 positive TAM. The relationship between PD-L1 expression and the clinical pathology was evaluated using χ(2) test. Spearman's rank correlations were used to determine the correlation between PD-L1 expression in tumor cells and macrophages.</p><p><b>RESULTS</b>Positive PD-L1 expression in primary cancer cells was found in 136 (65.3%) patients, which were negatively correlated with lymph node metastasis (P=0.009) and smoking history (P=0.036). Besides, TAM with PD-L1 expression (found in 116 patients) was positively associated with smoking history (P=0.034), well-differentiation (P=0.029) and negative lymph node metastasis (P=0.0096). A correlation between PD-L1 expression in primary tumor cells and non-small cell lung cancer associated macrophages was found (r=0.228, P=0.021).</p><p><b>CONCLUSION</b>PD-L1, secreted from TAM, might induce cancer cells apoptosis, and decrease lymph node metastasis.</p>

Effect of positive nutritional support strategy on extrauterine growth restriction in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the effects of positive nutritional support in the early stage after birth on the nutritional status during hospitalization and extrauterine growth restriction (EUGR) in preterm infants.</p><p><b>METHODS</b>There were two groups of preterm infants. Group A (n=99) was given the previous nutritional program, while group B (n=101) was given positive nutritional support. The nutritional intake, growth rate and EUGR incidence were compared between the two groups.</p><p><b>RESULTS</b>Compared with group A, group B had significantly higher enteral calorie intake and total calorie intake within one week after birth. Additionally, the age of first feeding, time of regaining birth weight, duration of intravenous nutrition, time to full enteral feeding, and length of hospital stay in group B were all shorter than in group A. Group B also had less physiological weight loss than group A. Among the preterm infants with a gestational age less than 32 weeks, group B had faster increases in body weight, head circumference, and body length and a lower incidence of EUGR compared with group A. Among the preterm infants with a gestational age not less than 32 weeks, group B had faster increases in body weight and a lower incidence of EUGR (evaluated based on body weight and head circumference) compared with group A. During hospitalization, group B had significantly lower incidence of feeding intolerance, necrotizing enterocolitis, and sepsis than group A.</p><p><b>CONCLUSIONS</b>Positive nutritional support strategy, applied in preterm infants early after birth, can effectively improve their nutritional status during hospitalization and reduce the incidence of EUGR without increasing the incidence of related complications during hospitalization.</p>

K-ras gene mutation in clinical diagnosis and risk factors of pancreatic cancer: A review / 第二军医大学学报

The early symptoms and laboratory findings of pancreatic cancer are nonspecific and the outcome of victims are poor. Currently surgical resection is the only means for cure. When pancreatic cancer is clinically suspected, it is usually non-resectable due to metastasis. So prevention and early diagnosis are especially important for pancreatic cancer. The risk factors of pancreatic cancer include male sex, old age, long-term smoking, coffee consumption, alcohol abuse, diabetes, chronic pancreatitis, hereditary factors, obesity, non-familial hypercholesterolemia, high caloric intake, and environmental factors. Many studies have indicated that pancreatic cancer is closely related to K-ras mutations, and patients with high susceptibility have a higher probability of K-ras mutations. This paper reviews the value of K-ras mutation in diagnosis of pancreatic cancer, K-ras mutation in pre-cancerous lesions, and the relation between high-risk factors and K-ras mutations.

Role of hypoxia-inducible factor-1α endothelin-1 and inducible nitric oxide synthase in the pathogenesis of hypoxia-induced pulmonary hypertension of the newborn / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the roles of hypoxia-inducible factor-1α (HIF-1α), endothelin-1 (ET-1) and inducible nitric oxide synthase (iNOS) in the pathogenesis of hypoxia-induced pulmonary hypertension (HPH) of the newborn.</p><p><b>METHODS</b>Seventy-five term hospitalized neonates with HPH (mild 29 cases, moderate 25 cases, severe 21 cases) and 22 term hospitalized neonates without HPH (control group) were enrolled between June 2006 and November 2009. Serum levels of HIF-1α, iNOS and ET-1 were measured using ELASA 1, 3 and 7 days after birth.</p><p><b>RESULTS</b>Serum concentrations of HIF-1α and ET-1 in the mild, moderate and severe HPH groups were significantly higher than those in the control group (P<0.01) 1 day after birth, and were related to the severity of HPH. The serum iNOS concentrations in the moderate and severe HPH groups were also significantly higher than those in the control group (P<0.01). By 3 days after birth, serum ET-1 concentration in the moderate HPH group and serum concentrations of HIF-1α, ET-1 and iNOS in the severe HPH group reminded significantly higher than those in the control group (P<0.05). At 7 days after birth, serum ET-1 concentration in the severe HPH group still remained higher than that in the control group (P<0.05).</p><p><b>CONCLUSIONS</b>Serum levels of HIF-1α, ET-1 and iNOS increase in neonates with HPH, resulting in an imbalance of ET-1 and NO. This may be of importance in the pathogenesis of neonatal HPH.</p>

Correlation between right ventricular function and the indexes of blood gas in neonates with hypoxic pulmonary hypertension / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the relationship of right ventricular function with the indexes of blood gas in neonates with hypoxic pulmonary hypertension (HPH).</p><p><b>METHODS</b>Sixty-seven neonates with HPH (29 mild, 23 moderate and 15 severe) and 22 gestational age- and weight-matched neonates without HPH (control group) were enrolled. On postnatal days 1, 3 and 7, pulmonary artery systolic pressure (PASP) was measured by pulsed Doppler echocardiography. Systolic wave of ventricular (Sa), early diastolic wave (Ea), late diastolic wave (Aa), and Ea/Aa ratio were determined by the tissue Doppler imaging (TDI) technology. Artery oxygen pressure (PaO(2)), fractional concentration of inspired oxygen (FiO(2)), and PaO(2)/ FiO(2) ratio were simultaneously observed.</p><p><b>RESULTS</b>On postnatal day 1, PaO(2) and PaO(2)/FiO(2) ratio as well as Ea and Ea/Aa ratio were significantly lower, while PASP was significantly higher in the HPH groups than those in the control group. Sa decreased in the moderate and severe HPH groups, Aa increased in the moderate HPH group, and Aa decreased significantly in the severe HPH group compared with that in the control group. On postnatal day 3, PaO(2) and PaO(2)/FiO(2) ratio returned to normal level in the mild and moderate HPH groups, while other indexes remained abnormal. On postnatal day 7, all the indexes above returned to normal level in the mild HPH group; Ea and Ea/Aa ratio were still significantly lower in the moderate HPH group, and the other indexes returned to normal level; in the severe HPH group, only PaO(2) and PaO(2)/FiO(2) ratio returned to normal level.</p><p><b>CONCLUSIONS</b>The changes and recovery of diastolic and systolic functions of right ventricular are not paralleled with hypoxia and PASP in neonates with HPH. It is helpful for the diagnosis and treatment of HPH by monitoring PASP and right ventricular function with TDI.</p>

Analysis on evaluation of medical device adverse events monitoring and some factors influencing MDAE's reporting by medical personnels / 中国医疗器械杂志

<p><b>OBJECTIVE</b>To investigate the knowledge level related to medical device adverse events (MDAEs) among medical personnels, some factors influencing the reporting behavior and supervision and administrative strategies.</p><p><b>METHODS</b>Stratified sampling, cluster sampling and random sampling were adopted together and a questionnaire survey was conducted among 1897 subjects from 33 hospitals.</p><p><b>RESULTS</b>Medical personnels knew a very little about MDAEs and medical devices' post-market monitoring, but their attitudes towards its benefits were positive. Their intentions to report MDAEs were relatively strong, but there were still some barriers about it.</p><p><b>CONCLUSION</b>A monitoring system and a professional training model about MDAEs reporting should be established and improved in hospitals.</p>

Plasma thromboxane A2 and prostaglandin I2 levels and their ratio in children with Henoch-Schonlein purpura nephritis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the changes and roles of plasma thromboxane A2 (TXA2) and prostaglandin I2 (PGT2) levels and their ratio in Henoch-Schonlein purpura nephritis (HSPN) in children.</p><p><b>METHODS</b>Plasma levels of TXA2 and PGI2 were measured using ELISA in 45 children with HSPN and 20 healthy children.</p><p><b>RESULTS</b>Plasma TXA2 level was significantly higher, while plasma PGI2 level was significantly lower in HSPN children in the acute phase than in the control (P<0.01). The ratio of TXA2/PGI2 in HSPN children in the acute phase was statistically higher than in the control (9.55+/-3.56 vs 0.87+/-0.21; P<0.01). In the convalescence phase, plasma TXA2 level remained higher and plasma PGI2 level was elevated and higher than in the control, so the ratio of TXA2/PGI2 was reduced to normal level.</p><p><b>CONCLUSIONS</b>The imbalance of TXA2 and PGI2 may be involved in the development of renal damage in children with HSPN. The balance of TXA2 and PGI2 contributes to renal recovery.</p>

Changes of Serum Cardiac Troponin I and Brain Natriuretic Peptide in Pediatric Heart Failure with Pneumonia and Their Relationship with Heart Function / 实用儿科临床杂志

Objective To investigate the changes of serum cardiac troponin I(cTnI)and brain natriuretic peptide(BNP)in heart failure of children with pneumonia and their relationship with heart function.Methods Thirty healthy children aged from 5 months to 3 years old were randomly selected with 17 male and 13 female(healthy group).Thirty children with severe heart failure aged from 3 months to 2 years old were selected at the same time with 21 male and 9 female(heart failure group).Thirty children with ordinary pneumonia aged from 3 months to 3 years old were also sampled with 16 male and 14 female(ordinary pneumonia group).The peripheral bloods of 2-3 mL of all children were taken.The BNP level were measured by enzyme-linked immunosorbent assay and the cTnI level was determined by micro-particle enzyme immunoluminescent.Left ventricular ejection fraction(LVEF) and left ventricular fractional shor-tening(LVFS)were detected by echocardiography.SPSS 11.0 software was used to analyze the data.Results The levels of cTnI [(0.389?0.030) ?g/L] and BNP [(0.572?0.090) ?g/L] of heart failure group increased significantly compared with healthy and ordinary pneumonia group,while their LVEF and LVFS decreased significantly(Pa

Multi-sfice CT pulmonary function evaluation in emphysema / 中华放射学杂志

Objective To explore the feasibility of evaluating the lung function by MSCT in emphysema.Methods The MSCT scan and pulmonary function tests(PFF)were respectively performed in 147 receptors within one week.They were randomly divided into 2 groups:group A(120 receptors), including normal,mild,moderate and severe abnormal pulmonary function based on the PFT,for comparing the correlation between pulmonary quantitative indexes of MSCT pulmonary function and PFT and settingup the primary grade criteria of abnormal pulmonary function in emphysema,group B(27 receptors)for evaluating the diagnostic accuracy in group A.The total lung was respectively scanned at the full inspiration and full expiration with MSCT.The pulmonary quantitative indexes of MSCT were measured with Siemens Pulmo pulmonary quantitative software.Results There was correlation between pulmonary quantitative indexes of MSCT and PFF.The Piex/in_(-910)showed best correlation with FEV_1%(r=-0.905,P