Objective To analyze the predictive value of serum copeptin, pentraxin 3 (PTX3), and soluble programmed cell death ligand 1 (sPD-L1) for poor prognosis in children with neonatal purulent meningitis. Methods Children with neonatal purulent meningitis admitted to the Department of Pediatrics, the Second Hospital of Handan between September 2020 and February 2023 were selected. According to the Gesell developmental scale score, the children were separated into a good prognosis group and a poor prognosis group. The correlation between serum levels of copeptin, PTX3, sPD-L1 and the prognosis of neonatal purulent meningitis were analyzed using Spearman correlation coefficient. The correlation of serum levels of copeptin, PTX3, and sPD-L1 with white blood cell count (WBC) and procalcitonin (PCT) were analyzed using Pearson correlation analysis. The area under the curve (AUC) of serum copeptin, PTX3, and sPD-L1 in predicting the prognosis of neonatal purulent meningitis were obtained by plotting the receiver operator characteristic curve. The factors affecting the prognosis of neonatal purulent meningitis were analyzed using multiple logistic regression analysis. Results A total of 107 children were included. Among them, 79 cases had good prognosis and 28 cases had poor prognosis. The serum levels of copeptin, PTX3, sPD-L1, WBC and PCT in the poor prognosis group were obviously higher than those in the good prognosis group (P<0.05). The levels of serum copeptin, PTX3, and sPD-L1 were positively correlated with the prognosis, WBC, and PCT of neonatal purulent meningitis (P<0.05). The results of logistic regression analysis showed that copeptin, PTX3, and sPD-L1 were risk factors affecting the prognosis of neonatal purulent meningitis (P<0.05). The AUC for predicting the prognosis of neonatal purulent meningitis with the combination of serum copeptin, PTX3, and sPD-L1 was 0.976, and the combined predictive value of the three was better than predicting separately (P<0.05). Conclusions Copeptin, PTX3, and sPD-L1 are abnormally upregulated in the serum of children with poor prognosis of neonatal purulent meningitis. The combination of the three can improve the predictive value for poor prognosis of neonatal purulent meningitis.
【摘要】 目的 觀察小劑量氯胺酮在健忘鎮痛麻醉輔助局部麻醉（局麻）剖宮產中的應用。方法 選擇1200例剖宮產的孕婦,隨機分為單純局麻組(L組)、氟芬強化局麻組(F組)和健忘鎮痛麻醉組(J組),每組400例。L組單純局麻;F組局麻術中輔以氟哌利多500 mg,芬太尼015 mg;J組在F組基礎上輔以氯胺酮,觀察各組患者麻醉誘導至胎兒娩出時間;新生兒1、5 min Apgar評分;手術中血壓相對于基礎值的波動情況;手術中及手術后出血情況及麻醉滿意度。 結果 J組與L組和F組比較,胎兒娩出時間無顯著差別;Apgar評分提高;手術中孕婦血壓波動不明顯;手術中及手術后出血量無明顯增加,麻醉滿意度明顯提高。 結論 由小劑量氯胺酮輔助實施的健忘鎮痛麻醉在局麻剖宮產中優于單純局麻和氟芬強化局麻,在剖宮產中尤其急診剖宮產中值得推廣。【Abstract】 Objective To observe the application of lowdose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia. Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups (400 cases in each group): simple local anesthesia group (group L), droperidolfentanyl strengthen local anesthesia group (group F) and analgestic and amnestic anesthesia group (group J). Group L was only local anesthesia. Group F was local anesthesia supplemented by droperidol 500 mg, fentanyl 015 mg. Group J was supplemented with ketamine on the basis of group F. Then the time from anesthesia to the fetus delivery, Neonatal Apgar score of one and five minutes, the blood pressure fluctuations, amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed. Results Compared with group L and F, the delivery time was no significant difference, Apgar score increased, blood pressure fluctuations in pregnant women was not obviously varied, amount of bleeding in or after surgery had no significantly increase, and the satisfaction of anesthesia improved markedly all in group J. Conclusions The analgestic and amnestic anesthesia assisted by lowdose ketamine, in cesarean section, is better than local anesthesia and strengthen local anesthesia by droperidolfentanyl, which is worthy to be popularized, especially in emergency caesarean section.
ObjectiveTo measure and analyze the tortuosity of retinal veins in neonatal and premature infants quantitatively. MethodsA retrospective clinical study. The fundus images of the left eyes were selected from 30 healthy neonates and 30 premature infants without retinopathy of prematurity underwent RetCam screening. There were 16 premature infants with a history of oxygen inspiration. The tortuosity of superior temporal veins, inferior temporal veins, superior nasal veins, inferior nasal veins was measured separately using a self-developed computer program. Pearson correlation analysis was used to analyze the relationship between tortuosity of retinal veins and birth weight, gestational age and correct gestational age. ResultsIn full-term neonatal infants, the vascular tortuosity of the nasal veins was significantly higher than the temporal veins (t=5.73, P < 0.01), while the superior veins and inferior veins showed no significant difference (t=0.39, P > 0.05). There was no correlation between vascular tortuosity of temporal (r=0.179, -0.175) or nasal veins (r=0.055, 0.345) with birth weight or gestational age (P > 0.05). In premature infants, the vascular tortuosity of the nasal veins was also significantly higher than the temporal veins (t=5.00, P < 0.01), no significant difference was found between the superior veins and inferior veins (t=0.39, P > 0.05). The vascular tortuosity of temporal veins of premature infants was negatively correlated with birth weight (r=-0.375, P < 0.05); however, no significant correlation was found with gestational age (r=-0.296, P > 0.05). The vascular tortuosity of the temporal retinal veins of premature infants with a history of oxygen inspiration was significantly higher than premature infants without a history of oxygen inspiration (t=2.517, P < 0.05), though no significant difference was found between the nasal veins (t=-0.261, P > 0.05). The vascular tortuosity of the temporal and nasal retinal veins of premature infants was both higher than neonate, but was not statistically significant (t=0.88, 1.50; P > 0.05). ConclusionsThe vascular tortuosity of the temporal veins was greater than the nasal veins in both full-term and premature infants, though no significant difference was found between superior and inferior veins. The vascular tortuosity of temporal veins of premature infants increased as birth weight decreased. The vascular tortuosity of the temporal retinal veins of premature infants with a history of oxygen inspiration was higher than premature infants without a history of oxygen inspiration.
Objective To investigate the relationship between the expression of hypoxia inducible factor 1α (HIF-1α) and the neuron apoptosis during a hypoxia ischemia brain damage and explore the role of HIF1α in regulating the neuron apoptosis and repairing the brain damaged by hypoxia and ischemia. Methods Forty SD rats aged 10 days were randomly divided into the experiment group and the control group, with 20 rats in each group. In the experimental group, the rats were anesthetized with ethylether. The right common carotid artery was exposed and ligated. Then, they were exposed to hypoxia ina normobaric chamber filled with 8% oxygen and 92% nitrogen for 2.5 hours. In the control group, the right common carotid artery was exposed but was not ligated or exposed to hypoxia. The brain tissues were harvested from the rats in the both groups at 4, 8, 24, 48 and 72 hours after the hypoxia and ischemia, and fromthe rats in the control group at the same time points. The HIF-1α protein expression and the cleaved caspase 3 (CC3) protein expression were detected with the immunohistochemistry method. The apoptosis cells were detected with the TUNEL staining method. Results In the experimental group, the HIF-1α expression was significantly increased at 4 hours after operation, at the peak level at 8 hours, and began to decrease at 24 hours. The CC3 protein was expressed at 4 hours after operation, and was slightly expressed at 8 hours, but was significantly increased at 24 hours; the higher levels were maintained at 48 and 72 hours. However, in the control group, both the expression levels of HIF-1α and the CC3 protein were extremely low. So, the expression levels of HIF-1α andthe CC3 protein were significantly higher in the experimental group than in the control group (P＜0.01). The TUNEL staining showed that in the experimentalgroup the positive cells were significantly increased after the hypoxia and ischemia, with a peak level at 72 hours after the hypoxia and ischemia; however, in the control group there were few positive cells.TUNEL positive cells in the experimental group were significantly more than that in the control group(P＜0.01).ConclusionThe expression tendency of HIF-1α is completely different from that of CC3.HIF-1α may have a protective role in regulating the neuron apoptosis in the neonatal hypoxia-ischemia brain damage and may promote the repairing and rebuilding process in the brain that was damaged by hypoxia and ischemia.
Objective To overview the characteristic in development and progress of retinopathy of prematurity (ROP). Method Six hundred and thirty eight premature birth infants with birth weight less than 2000 grams born or hospitalized in three hospitals in Guangdong province were examined by indirect ophthalmoscopy as part of ROP screening. 1172 eyes in 586 infants are included. Follow-up has not been completed in 52 infants. The first time of screening was 4 to 6 weeks after birth or 32 weeks corrected for gestational age. Threshold and pre-threshold (type I) disease was treated by laser photo-coagulation within 48 hours. All infants were followed until complete vascularization, natural regress or for more than 1 month after effective therapy. Data regarding incidence of ROP, corrected gestational age and days after birth of ROP onset, corrected gestational age and days after birth of getting treatment, progress pace and prognosis were collected and analyzed by Spearman statistical analyses. ResultsIn 1172 eyes, ROP developed in 118 eyes (10.07%). In 1054 eyes (89.93%) were completed vascularized. Sixty eyes received laser treatment. In ROP infants, the median gestational age was 29.3 weeks and the median corrected gestational age and days after birth when ROP develops were 36.4 weeks and 59.5 days respectively. There was a negative correlation between gestational age and ROP development and treatment timing （R=-0.65,-0.80；P=0.000）.The median interval days from stage 1 to stage 2, from stage 2 to stage 3, and stage 3 to getting treatment were 14.0, 10.5 and 3.0 days respectively. The interval showed a nonnormal distribution and there is statistical difference （H=30.69，P=0.000）.During the follow-up after treatment, the ocular fixation and following reactions were normal. The structure of optic disc, the macula lutea and retina were normal. ConclusionsTiming of ROP development is about 36.4 weeks corrected for gestational age and 37.5 weeks when treated. The interval is shorter when ROP progresses.The prognosis is good for the treatment of aular.
Objective To establish a model of transplanting neonatal cardiomycytes into the wall of rat inferior vena cava. Methods Neonatal cardiomyocytes (n=6, 5×106cells each, A group) or medium (n=6, B group) only were transplanted into the wall of inferior vena cava in female Fisher rats. At 21 days after transplantation, the contraction of transplanted cardiomyocytes was assessed and the inferior vena cava was processed for histology. Results Distinct rhythmic beating of the vena cava at the site of cell transplantation before and after the aorties were clamped (at a rate 141± 47 rpm and 88± 44 rpm which was dramaticly lower than aortic beating, with a statistical difference at P value of 0.03). Cardiomyocyte was seen in 6 rats who had neonatal cardiomyocyte transplantation, but not in 6 rats receiving media. Hematoxylin and eosin staining showed viable cardiomyocytes in the wall of the vena cava in 6 rats treated with neonatal cardiomyocytes, but not in 6 rats receiving media. Conclusion This study shows that neonatal cardiomyocytes can survive, mature and spontaneously and rhythmically contract after they are transplanted in the wall of inferior vena cava.
Objective To observe the systemic inhalation anesthetic effects of preterm children with different gestational ages under ocular fundus examination, and to assess its safety. Methods Fifty-one preterm children with retinopathy of prematurity (ROP) were included in the study. These kids were divided into 2 groups, group Ⅰ included 24 kids with a corrected gestational age of 33 to ＜44 weeks, and group Ⅱ included 27 kids with a corrected gestational age of 44 to 64 weeks. The preterm months were same (t=-1.3.P＞0.05), but the body weights were different (t=-10.5.P＜0.05) between these two groups. Anesthesia was induced by inhalation of 6% sevoflurane, and the period from the beginning of inhalation to disappearance of body movement was the induction time. 6% sevoflurane was inhaled continuously for another period of the induction time, and then the concentration of sevoflurane was adjusted to a maintenance concentration. The initial maintenance concentration was 3%, and was adjusted by 0.5% each time. Sequential method was used to determine the subsequent maintenance concentration. If the preceding patient had not moved during the maintenance period, the sevoflurane concentration was decreased by 0.5% for the next patient. If the preceding patient had moved during the maintenance period, the sevoflurane concentration was increased by 0.5% for the next patient. Respiratory depression and cough during the induction and maintenance period, duration of anesthesia and recovery time were recorded. Choking and vomiting during drinking or milk-feeding in one hour after the ocular fundus examination were also recorded. Results The effective inhale concentration in 50% patient of sevoflurane was 2.5% in group Ⅰ, 2.9% in group Ⅱ. The average maintenance concentration was (2.5plusmn;0.5)% in group Ⅰ, (3.0plusmn;0.5)% in group Ⅱ. The difference was statistically significant (t=-3.3.P＜0.05). The average duration of anesthesia and the average awake time were the same (t=0.04 and -1.0 respectively.P＞0.05) between these two groups. The average induction time was significantly shorter in group Ⅰ than in group Ⅱ, the difference was statistically significant (t=-4.9.P＜0.05). All patients were successfully completed the ocular examination. No respiratory depression or cough occurred during and after the examination. No choking and vomiting during drinking or milkfeeding in one hour after the ocular fundus examination. Conclusion Anesthesia with inhaled sevoflurane by a face mask is safe for preterm outpatients undergoing fundus examination.
Objective To learn the screening results of retinopathy o f prematur ity (ROP) of the preterm infants in three hospitals in Shenzhen. Metho ds From Jan. 2004 to Jan. 2007, 1372 preterm infants (2744 eyes) with birth weight lt;200 0 g or but the ones having severe systemic disease in Shenzhen People's Hospita l, Shenzhen Maternity and Child Healthcare Hospital and Shenzhen Eye Hospital we re screened for ROP with binocular indirect ophthalmoscope and (or) widefield digital pediatric retinal imaging system (RetCamII). Cryotherapy or laser photoco agulation was performed if threshold or pre-threshold type I ROP was found. All preterm infants were followed up until retina is completely vascularized or the disease regressed. Results In all the infants, 218 cases (436 eyes) (15.9％) developed ROP, including 190 eyes (6.9％) suffering from threshold or pre-threshold type 1 ROP, 16 eyes (0.6％) from stage 4 or stage 5, and 230 eyes (8.4％) from stages below threshold or pre-threshold type 1 ROP. There were 435 infants ( 870 eyes) (31.7%) with BW of 1500g or less, in which 236 eyes (27.1％) developed ROP, including 126 eyes (14.5％) suffering from threshold or pre-threshold type 1 ROP, 10 eyes (1.1％) from stage 4 or stage 5, and 100 eyes (11.5％) from stages below threshold or pre-threshold type 1 ROP. There were 137 infants 274 eyes (10%) with BW of 1250g or less, in which 108 eyes (39.4％) developed ROP, including 60 eyes (21.9％) suffering from th reshold or pre-threshold type 1 ROP, 4 eyes (1.4％) from stage 4 or stage 5, and 44 eyes (16％) from stages below threshold or pre-threshold type 1 ROP. Th eincidence of ROP（chi;2=60.43，Plt;0.001）, the incidence of threshold or pre-threshold type 1 ROP（chi;2=46.82，Plt;0.001）and the incidence of below threshold or pre-threshold type 1 ROP （chi;2=10.71，P=0.005）among the total group, BWle;1500g group and BWle;1250g group had statistical differences. Conclusions The incidence of ROP in the three hospitals in Shenzhen was lower. However, the incidence of severe ROP (threshold or pre-threshold type 1 ROP) was higher. Birth weight is an important factor to affect ROP incidence.
ObjectiveTo systematically review the economics evaluation studies on the early screening or diagnosis of primary immunodeficiency diseases (PID). MethodsWeb of Science, CRD, PubMed, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect the economics evaluation studies on the early screening or diagnosis of PID from inception to July 1st, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, a descriptive systematic review was performed. ResultsA total of 10 studies focusing on SCID were included. The results showed that under a relatively high threshold, the early screening and diagnosis of SCID were cost-effective, which can reduce severe infections in patients and treatment costs while improving patient’s survival. ConclusionCurrent evidence shows that early diagnosis of PID can reduce costs and improve benefits. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To investigate the expression of hypoxia inducible factor 1α (HIF-1α) protein and the activation of phosphoinositid 3-kinase/Akt (PI3K/Akt) signal ing pathway in neurons under hypoxia ischemia condition,and to elucidate the role of PI3K/Akt on HIF-1α regulation in the developing neurons after hypoxia ischemia brain damage(HIBD). Methods Fifty-six SD rats aged 10 days were randomly divided into normal control group (n=12), sham operationgroup (n=12), experimental group (n=24), wortmannin treated group (n=4) and DMSO/PBS treated group (n=4). In theexperimental group, the rats were anesthetized with ethylether. The right common carotid artery was exposed and l igated. Then, they were exposed to hypoxia in a normobaric chamber filled with 8% oxygen and 92% nitrogen for 2.5 hours. In the sham control group, the right common carotid artery was exposed but was not l igated or exposed hypoxia. In the normal control group, the rats recevied no further processing. For wortmannin treated group and DMSO/PBS treated group, the rats received intraventricular injection of wortmannin or DMSO/PBS 30 minutes before hypoxia ischemia. The brain tissues were harvested from the rats in the normal control, sham operation and experimental groups at 4, 8 and 24 hours after hypoxia ischemia, but in the wortmannin and DMSO/PBS treated groups only at 4 hours. The HIF-1α protein expression and Akt protein expression were detected with immunohistochemistry method. HIF-1α, Akt and p-Akt protein expression were measured by Western blot analysis. Results In the experimental group, the HIF-1α expression was significantly increased at 4 hours after operation, reached the peak level at 8 hours, and began to decrease at 24 hours. The p-Akt protein was significantly increased at 4 hours, and began to decrease at 8 hours. However, the expression levels of HIF-1α and p-Akt protein in the normal control group were extremely low at each time point. So, the expression levels of HIF-1α in the experimental group was significantly higher than that in the normal control groups (P lt; 0.01), the expression of p-Akt protein in the experimental group at 4 and 8 hours was significant higher than that in the normal control group (P lt; 0.05). The change of Akt protein in the experimental group was not time-dependent, and no significant difference was evident when compared with that of the normal control group (P gt; 0.05). Using wortmannin, the PI3K/Akt specific inhibitor, HIF-1α protein expression was significantly decreased when compared with the DMSO/PBS treated group and experimental group (P lt; 0.01). Conclusion These results suggested that the HIBD of neonatal rats may activate PI3K/Akt signal ing pathway and further induce the expression of HIF-1α, indicating PI3K/Akt signal ing pathway and HIF-1α could be a potential target for treatment of neonatal HIBD.