Management and prognosis of extremely preterm infants with gestational age ≤25+6 weeks / 中华儿科杂志

Objective: To investigate the outcomes including major complications and prognosis of extremely preterm infants with gestational age ≤25+6 weeks. Methods: The cross-sectional study enrolled 233 extremely preterm infants with gestational age ≤25+6 weeks who were admitted to the Department of Neonatology of Shenzhen Maternity and Child Healthcare Hospital from January 2015 to December 2021. The clinical data including perinatal factors, treatments, complications, and prognosis were extracted and analyzed. These extremely preterm infants were also grouped according to gestational age and year of admission to further analyze their survival rate, major complications, causes of death, and long-term outcomes. The comparisons between the groups were performed with Chi-square test and Kruskal-Wallis. Results: Among these 233 extremely preterm infants, 134 (57.5%) were males and 99 (42.5%) females. The gestational age was (24.6±0.9) weeks, the birth weight was 710.0 (605.0,784.5) g, and the overall survival rate was 61.8% (144/233). Among the surviving extremely preterm infants, the earliest gestational age was 22+2 weeks and the lowest birth weight was 390 g. There were 17.6% (41/233) of extremely preterm infants had treatment withdrawn and were discharged in line with the will of guardians. Among the rest 192 extremely preterm infants managed with aggressive treatments, 14 (7.3%) died in hospital and 34 (17.7%) had treatment withdrawn later due to severe complications. Of the 192 extremely preterm infants, 144 (75.0%) survived, and the survival rate increased year by year (χ2=26.28, P<0.001) while the mortality decreased year by year (χ2=14.09, P=0.027). Among the survivors, 20.8%(30/144) had no major complications, and the incidence of complications was also negatively related with the gestational age (χ2=7.24, P=0.044), and the length of invasive ventilation was negatively related to the gestational age (χ2=29.14, P<0.001). In the group of less than 23+6 weeks, all extremely preterm infants had one or more major complications. The follow-up were completed in 122 infants and revealed that delayed motor development, language retardation, and hearing and vision impairment accounted for 17.2% (21/122), 8.2% (10/122) and 17.2% (21/122), respectively. Conclusions: Extremely preterm infants with gestational age ≤25+6 weeks are difficult to treat, but the survival rate of infants undergoing aggressive treatments increases year by year. Although the prevalence of major complications is still high, most extremely preterm infants have acceptable prognosis during follow-up.

Therapeutic effect of acupuncture combined with medication on chronic prostatitis of damp and heat stasis / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect of electroacupuncture (EA) combined with tamsulosin hydrochloride sustained release capsule on chronic prostatitis (CP) of damp and heat stasis.@*METHODS@#A total of 70 patients with CP of damp and heat stasis were randomized into an acupuncture plus medication group (35 cases, 4 cases dropped off) and a medication group (35 cases, 5 cases dropped off). In the medication group, tamsulosin hydrochloride sustained release capsule was given orally, 0.2 mg a time, once each night. On the basis of treatment in the medication group, EA was applied at Guanyuan (CV 4), Sanyinjiao (SP 6) and Yinglingquan (SP 9), with disperse-dense wave, 5 mA in intensity for 30 min. Treatment for 30 days was as one course, and totally 3 courses were required in both groups. Before treatment, 1, 2, 3 months into treatment and at the follow-up of 2 months after treatment, the TCM syndrome score and National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) score were observed, and the clinical efficacy was evaluated in both groups.@*RESULTS@#Compared before treatment, the TCM syndrome scores of 3 months into treatment and follow-up were decreased in the acupuncture plus medication group (@*CONCLUSION@#Acupuncture combined with medication can improve the clinical symptoms in patients with CP of damp and heat stasis, and its therapeutic effect is superior to simple western medication.

Clinical value of droplet digital PCR in rapid diagnosis of invasive fungal infection in neonates / 中国当代儿科杂志

OBJECTIVE@#To evaluate the clinical value of droplet digital PCR (ddPCR) in rapid and accurate diagnosis of invasive fungal infection (IFI) in neonates.@*METHODS@#The highly conserved sequence of fungi 18S RNA was selected as the target sequence, and primers were designed to establish a ddPCR fungal detection system. Blood samples were collected from 83 neonates with high-risk factors for IFI and/or related clinical symptoms in the neonatal intensive care unit (NICU) of a hospital in Shenzhen, China. Blood culture and ddPCR were used for fungal detection.@*RESULTS@#The ddPCR fungal detection system had a specificity of 100% and a sensitivity of 3.2 copies/μL, and had a good reproducibility. Among the 22 blood samples from neonates with a confirmed or clinical diagnosis of IFI, 19 were detected positive by ddPCR. Among the 61 blood samples from neonates who were suspected of IFI or had no IFI, 2 were detected positive by ddPCR.@*CONCLUSIONS@#The ddPCR technique can be used for the detection of neonatal IFI and is a promising tool for the screening and even diagnosis of neonatal IFI.

Comparative analysis of serum IgE detected by ImmunoCAP and EUROLine assays / 医学研究生学报

Objective The diagnosis of allergic diseases mainly relies on the allergen skin test or in vitro specific IgE test. This study was to explore the diagnostic efficiency of EUROLine and its application in southern China by reference to the standard method of the immunoenzymatic capsulated hydrophilic carrier polymer (ImmunoCAP).Methods Using the EUROLine system, we examined 12 common specific IgEs (sIgE) from 283 patients with multiple sensitizations in the First Affiliated Hospital of Guangzhou Medical University, including cockroach (i6), dog dander (e2), cat dander (e1), Mugwort (w6), ragweed (w1), dust mites (ds1), chicken protein (f1), milk (f2), crab (f23), shrimp (f24), peanut (f13) and soybean (f14).Results EUROLine showed that house dust mite allergens were the main aeroallergens in southern China, with a positive rate of 66.3%, while egg white had the highest positive rate (53.2%) in food allergens. The overall rate of the allergens detected by EUROLine was consistent to that of ImmunoCAP by 60.8%-90.1%, the positive rate by 63.3%-93.6%, and the negative rate by 54.5%-95.2%. The Kappa value of EUROLine was 0.203-0.702 in detecting each allergen and >0.6 with cat hair, egg white, peanut, milk and mugwort. The rank correlation coefficient between ImmunoCAP and EUROLine was >0.7 for dust mite combination, cat hair, mugwort, egg white, milk, peanut and crab allergens, with the highest consistency rate for egg white (93.17% \[191/205\]), the lowest for shrimp (70.83% \[170/240\]), and an overall consistency rate of 82.68% (1542/1865).Conclusion The EUROLine system has a high diagnostic performance, and it is inexpensive, efficient and applicable in the detection of allergens in southern China.

Fat emulsion tolerance in preterm infants of different gestational ages in the early stage after birth / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the fat emulsion tolerance in preterm infants of different gestational ages in the early stage after birth.</p><p><b>METHODS</b>A total of 98 preterm infants were enrolled and divided into extremely preterm infant group (n=17), early preterm infant group (n=48), and moderate-to-late preterm infant group (n=33). According to the dose of fat emulsion, they were further divided into low- and high-dose subgroups. The umbilical cord blood and dried blood filter papers within 3 days after birth were collected. Tandem mass spectrometry was used to measure the content of short-, medium-, and long-chain acylcarnitines.</p><p><b>RESULTS</b>The extremely preterm infant and early preterm infant groups had a significantly lower content of long-chain acylcarnitines in the umbilical cord blood and dried blood filter papers within 3 days after birth than the moderate-to-late preterm infant group (P<0.05), and the content was positively correlated with gestational age (P<0.01). On the second day after birth, the low-dose fat emulsion subgroup had a significantly higher content of short-, medium-, and long-chain acylcarnitines than the high-dose fat emulsion subgroup among the extremely preterm infants (P<0.05). In the early preterm infant and moderate-to-late preterm infant groups, there were no significant differences in the content of short-, medium-, and long-chain acylcarnitines between the low- and high-dose fat emulsion subgroups within 3 days after birth.</p><p><b>CONCLUSIONS</b>Compared with moderate-to-late preterm infants, extremely preterm infants and early preterm infants have a lower capacity to metabolize long-chain fatty acids within 3 days after birth. Early preterm infants and moderate-to-late preterm infants may tolerate high-dose fat emulsion in the early stage after birth, but extremely preterm infants may have an insufficient capacity to metabolize high-dose fat emulsion.</p>

Clinical application of low-molecular-weight heparin (Fraxiparine) in rescuing venous crisis of island skin flap / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of low molecular weight heparin (Fraxiparine) in rescuing venous crisis of island skin flap.</p><p><b>METHODS</b>Of the 73 patients with venous crisis of island skin flap, 47 received subcutaneous injection of low-molecular-weight heparin (group I) and 26 were treated with phlebotomy, local compression and topical application of unfractionated heparin solution gauze (group II).</p><p><b>RESULTS</b>The flap survival ratio was (88.46∓8.64)% in group I and (38.37∓6.53)% in group II (P<0.001). At 0, 2, and 4 h after injection of low-molecular-weight heparin, the activated partial thromboplastin time (APTT) was obviously delayed (24.28∓6.71, 41.35∓7.64 and 32.34∓6.35, respectively, P<0.01), FXa:C level was significantly decreased (152.4∓30.7, 65.8∓24.4 and 83.4∓18.4, respectively, P<0.01), while FIIa:C level underwent no obvious alterations (155.70∓31.61, 143.20∓24.75, and 143.4∓23.35, respectively, P=NS).</p><p><b>CONCLUSION</b>Fraxiparine has good antithrombotic efficacy in rescuing venous crisis of island skin flap without adverse effect on systemic coagulation.</p>

Establishment of a rat model of bone marrow mesenchymal stem cell transplantation for repairing full-thickness skin defect / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish a rat model of full-thickness skin defect to receive bone marrow mesenchymal stem cell transplantation for wound repair.</p><p><b>METHODS</b>A full-thickness skin defect measuring 4 cmx4 cm in 36 F344 rats, which were divided into 3 groups with the wound covered with alloskin graft, acellular dermal matrix, or petrolatum gauze. In vitro cultured BMSCs in the 5th passage were transplanted into the skin defect, and the time of wound dressing dissociation and number of transplanted Brdu-positive cells in the wound were observed 14 days later.</p><p><b>RESULTS</b>The alloskin graft resulted in significantly longer time before dressing dissociation, with greater number of Brdu-positive cells in the wound than the other two wound dressings (P<0.001). The acellular dermal matrix showed better effect than petrolatum gauze in terms of the dressing dissociation time and the viable transplanted cell number in the wound.</p><p><b>CONCLUSION</b>Alloskin graft can be ideal for covering the wound surface to protect the transplanted BMSCs in rats.</p>

Recombinant human epithelial growth factor accelerates healing of cervical erosion / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of recombinant human epithelial growth factor (rhEGF) in promoting the healing of cervical erosion.</p><p><b>METHODS</b>Forty-eight patients with cervical erosion were treated with rhEGF and 30 with 500 kHz high-frequency electromagnetic wave, and the effects of the therapies were compared in terms of healing of the cervical wound, healing time, volume of vaginal discharge and bleeding and the lasting time.</p><p><b>RESULTS</b>In comparison with radiofrequency therapy, the healing of the lesion took significantly shorter time with rhEGF therapy, which also resulted in less vaginal discharge that lasted for shorter time without causing vaginal bleeding.</p><p><b>CONCLUSION</b>rhEGF can obviously accelerate the healing of cervical erosion.</p>