Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using ...Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using a self-administered questionnaire.Multiple logistic regression was conducted to test the associated factors with the dependent variables.Results:Only 9.3%of participants had a standardized level of knowledge,while 68.9%reported adequate skills for neonatal resuscitation.Factors associated with a standardized level of knowledge were age(p=0.001)and supportive supervision(p=0.007).Factors associated with the standardized practice level were the presence of hospital guidelines(p=0.028),previous training of nurses(p=0.011),and the presence of supportive supervision(p<0.001).Conclusions:The majority of emergency nurses in Hebron hospitals demonstrated a substandard level of knowledge of neonatal resuscitation.However,most of those nurses surprisingly reported a standardized practice level.The presence of hospital guidelines,training programs,or direct supervision for nurses are factors that can be considered to improve both knowledge and practice toward neonatal resuscitation among emergency nurses in Hebron.展开更多
Breast milk represents the gold standard for neonatal nutrition,especially for preterm and term infants with a low birthweight.This awareness is based not only on the nutritional properties of human milk,which is spec...Breast milk represents the gold standard for neonatal nutrition,especially for preterm and term infants with a low birthweight.This awareness is based not only on the nutritional properties of human milk,which is specifically designed for the growth of humans but also on breast milk’s non-nutritional properties,such as protection against infection.In fact,breast milk should be considered a heterogeneous ecosystem,including a wide range of cells in addition to those involved in immune function;growth factors,such as vascular endothelial growth factor;multiple noncoding microRNAs;immune cells;epithelial cells and multipotent mesenchymal stem cells.This recent identification of a pool of progenitor stem cells in human milk is the driving force behind the growing research aimed at identifying the nature of these stem/progenitor cells and their sources.展开更多
BACKGROUND Congenital hypothyroidism(CH)is a prevalent childhood endocrine disorder associated with irreversible neurological consequences.Its global incidence is on the rise.AIM To estimate CH incidence in Jordan and...BACKGROUND Congenital hypothyroidism(CH)is a prevalent childhood endocrine disorder associated with irreversible neurological consequences.Its global incidence is on the rise.AIM To estimate CH incidence in Jordan and assess the potential utility of incorporating(fT4)measurements into the screening process.METHODS This retrospective analysis examined thyroid function test results for infants born at our center between 2016 and 2020.Infants born before 28 weeks and those screened after 14 days of life were excluded.Screening occurred between days 3 and 7 of life,and thyroid-stimulating hormone(TSH)and T4 levels were measured concurrently from peripheral venipuncture blood samples.A TSH cutoff of<5 mIU/L was considered normal.Values between 5 and 20 mIU/L were equivocal,requiring repeat tests.TSH levels exceeding 20 mIU/L were considered critical.RESULTS A total of 10521 infants were included in the study,and 26 were diagnosed with CH,yielding an incidence of 1 in 400 live births.Females constituted 57.7%of CH cases.All CH cases had initial TSH values exceeding 5.0 mIU/L,with clustering above 20 mIU/L.Six CH infants had Down syndrome,accounting for 23.1%of CH cases.CONCLUSION Our study revealed a high incidence of CH in Jordan,marking a significant increase from previously reported rates.We recommend a national study to investigate risk factors and underlying causes of CH in our population.Furthermore,we advocate for the use of TSH alone with a cutoff value of<5 mIU/L for screening purposes.展开更多
Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to t...Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to the Yichang Central People’s Hospital from January 2023 to December 2024 were selected as study subjects based on the inclusion and exclusion criteria,and all subjects underwent bedside craniocerebral ultrasonography and MRI,and the results of MRI were used as the gold standard to divide the infants into the brain-injury group(n=31)and the no-brain-injury The children were divided into brain injury group(n=31)and no brain injury group(n=97),and the value of bedside cranial ultrasonography for early diagnosis of brain tissue injury in neonates with intrauterine distress was analyzed.Results:(1)Among the 128 cases of intrauterine distress neonates,31 cases were examined for abnormal signs,including 22 cases(70.97%)examined by bedside craniocerebral ultrasonography and 28 cases(90.32%)examined by MRI.(2)Bedside cranial ultrasound detected hypoxic-ischemic encephalopathy in 6 cases,accounting for 4.69%,ventricular widening in 2 cases,accounting for 1.56%,intracranial hemorrhage in 8 cases,accounting for 6.25%,periventricular softening of white matter in 5 cases,accounting for 3.91%,and cerebral edema in 1 case,accounting for 0.78%,while MRI detected hypoxic-ischemic encephalopathy in 9 cases,accounting for 7.03%.3 cases of ventricular widening,accounting for 2.34%,4 cases of intracranial hemorrhage,accounting for 3.13%,9 cases of periventricular-intraventricular white matter softening,accounting for 7.03%,and 3 cases of cerebral edema,accounting for 2.34%were examined.Among them,the detection rate of periventricular-intraventricular hemorrhage by bedside cranial ultrasound was significantly higher than that of MRI(P<0.05).Conclusion:The diagnostic value of bedside cranial ultrasound in periventricular-intraventricular hemorrhage is high,but the diagnostic value is not as good as that of MRI in other brain tissue injuries,and clinically appropriate examination protocols can be selected according to the specific types of craniocerebral injuries.展开更多
BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital...BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system.Truncus arteriosus(TA)is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation,leading to complications such as pulmonary hypertension,heart failure,and severe hypoxia.Although rare individually,the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges,with limited documentation in medical literature.CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1,pre-senting with respiratory distress,cyanosis,and altered spinal curvature.This case demonstrates the complexity of managing neonates with multiple congenital de-fects.Here,the patient was managed with oxygen supplementation,heart failure medication,nasogastric feeding,and multidisciplinary care to optimize her for surgical corrections.A coordinated,interdisciplinary approach was employed to optimize outcomes,particularly in a resource-limited setting.Immediate re-spiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival.CONCLUSION Recognizing co-existing congenital anomalies and their embryological interre-lation is critical in holistic patient care,particularly during neonatal and infancy.展开更多
Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find o...Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1,2014 to December 31,2016.Clinical data(baseline maternal status,preoperative status,perioperative information,maternal and fetal outcomes)of parturients and neonates were collected and analyzed.We summarized the common reasons for applying general anesthesia,and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists(ASA)grade,gestational weeks and intraoperative blood loss,as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study.Among the maternal and fetal factors,pregnancy with internal or surgical diseases is the most common reason(59 cases,60.2%)for choosing GA,followed by the placenta and fetal membrane abnormalities(38 cases,38.8%)and the pregnancy-specific disorders(36 cases,36.7%).ASA gradeⅢ-Ⅳof parturients(χ2=44.3,P<0.05),gestation period<37 weeks(χ2=23.4,P<0.05),and blood loss>800 ml(χ2=5.5,P<0.05)were related to the higher postoperative intensive care unit(ICU)rate in parturients.ASA gradeⅢ-Ⅳof parturients(t=-2.99,P<0.05),gestation period<37 weeks(t=2.47,P<0.05)were related to the longer hospital stay.ASA gradeⅢ-Ⅳof parturients(t=2.21,P=0.01)and gestation period<37 weeks(t=-3.21,P=0.002)were related to the lower one-minute Apgar score of neonates.Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS.High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.展开更多
AIM: To determine the etiology and prognostic factors for neonatal gastric perforation(NGP), a rare but life-threatening disease.METHODS: Between 1980 and 2011, nine patients un-derwent surgical intervention for NGP a...AIM: To determine the etiology and prognostic factors for neonatal gastric perforation(NGP), a rare but life-threatening disease.METHODS: Between 1980 and 2011, nine patients un-derwent surgical intervention for NGP at Seoul National University Children's Hospital. The characteristics and prognosis of the patients were retrospectively analyzed.RESULTS: Among the nine patients, three(33.3%) were preterm babies and five(55.5%) had associated anomalies, which included diaphragmatic eventration(n = 2), congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, and antral web. Three(33.3%) patients were born before 1990 and three(33.3%) had a birth weight < 2500 g. Pneumo-peritoneum was found on preoperative images in six(66.7%) patients, and incidentally in the other three(33.3%) patients. Surgery was performed within 24 h after the onset of symptoms in seven(77.8%) patients. The overall mortality rate was 22.2%(2/9). The time between symptoms and surgical intervention was the only prognostic factor for survival, whereas premature birth and birth weight were not.CONCLUSION: Early detection and advances in neo-natal intensive care may improve the prognosis of NGP.展开更多
Lead ion （Pb2＋） has been proven to be a neurotoxin due to its neurotoxicity on mammalian nervous system, especially for the developing brains of juveniles. However, many reported studies involved the negative effec...Lead ion （Pb2＋） has been proven to be a neurotoxin due to its neurotoxicity on mammalian nervous system, especially for the developing brains of juveniles. However, many reported studies involved the negative effects of Pb2＋ on adult neural cells of humans or other mammals, only few of which have examined the effects of Pb2＋ on neural stem cells. The purpose of this study was to reveal the biological effects of Pb2＋from lead acetate [Pb （0H30OO）2] on viability, proliferation and differentiation of neural stem cells derived from the hippocampus of newborn rats aged 7 days and adult rats aged 90 days, respectively. This study was carried out in three parts. In the first part, 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyltetrazolium bromide assay （MTT viability assay） was used to detect the effects of Pb2＋ on the cell viability of passage 2 hippocampal neural stem cells after 48-hour exposure to 0-200 pM Pb2＋. In the second part, 10 pM bromodeoxyuridine was added into the culture medium of passage 2 hippocampal neural stem cells after 48-hour exposure to 0- 200 pM Pb2＋, followed by immunocytochemical staining with anti-bromodeoxyuridine to demonstrate the effects of Pb2＋ on cell proliferation. In the last part, passage 2 hippocampal neural stem cells were allowed to grow in the differentiation medium with 0-200 pM Pb2＋. Immunocytochemical staining with anti-microtubule-associated protein 2 （a neuron marker）, anti-glial fibrillary acidic protein （an astrocyte marker）, and anti-RIP （an oligodendrocyte marker） was performed to detect the differentiation commitment of affected neural stem cells after 6 days. The data showed that Pb2~ inhibited not only the viability and proliferation of rat hippocampal neural stem cells, but also their neuronal and oligodendrocyte differentiation in vitro. Moreover, increased activity of astrocyte differentiation of hippocampal neural stem cells from both newborn and adult rats was observed after exposure to high concentration of lead ion in vitro. These findings suggest that hippocampal neural stem cells of newborn rats were more sensitive than those from adult rats to Pb2＋cytotoxicity.展开更多
Maintaining glutamate homeostasis after hypoxic ischemia is important for synaptic function and neural cell activity,and regulation of glutamate transport between astrocyte and neuron is one of the important modalitie...Maintaining glutamate homeostasis after hypoxic ischemia is important for synaptic function and neural cell activity,and regulation of glutamate transport between astrocyte and neuron is one of the important modalities for reducing glutamate accumulation.However,further research is needed to investigate the dynamic changes in and molecular mechanisms of glutamate transport and the effects of glutamate transport on synapses.The aim of this study was to investigate the regulatory mechanisms underlying Notch pathway mediation of glutamate transport and synaptic plasticity.In this study,Yorkshire neonatal pigs(male,age 3 days,weight 1.0–1.5 kg,n=48)were randomly divided into control(sham surgery group)and five hypoxic ischemia subgroups,according to different recovery time,which were then further subdivided into subgroups treated with dimethyl sulfoxide or a Notch pathway inhibitor(N-[N-(3,5-difluorophenacetyl-l-alanyl)]-S-phenylglycine t-butyl ester).Once the model was established,immunohistochemistry,immunofluorescence staining,and western blot analyses of Notch pathway-related proteins,synaptophysin,and glutamate transporter were performed.Moreover,synapse microstructure was observed by transmission electron microscopy.At the early stage(6–12 hours after hypoxic ischemia)of hypoxic ischemic injury,expression of glutamate transporter excitatory amino acid transporter-2 and synaptophysin was downregulated,the number of synaptic vesicles was reduced,and synaptic swelling was observed;at 12–24 hours after hypoxic ischemia,the Notch pathway was activated,excitatory amino acid transporter-2 and synaptophysin expression was increased,and the number of synaptic vesicles was slightly increased.Excitatory amino acid transporter-2 and synaptophysin expression decreased after treatment with the Notch pathway inhibitor.This suggests that glutamate transport in astrocytes-neurons after hypoxic ischemic injury is regulated by the Notch pathway and affects vesicle release and synaptic plasticity through the expression of synaptophysin.展开更多
The present study aimed to examine the effectiveness of bi-level positive airway pressure(BiPAP)versus continuous positive airway pressure(CPAP)in preterm infants with birth weight less than 1500 g and respiratory dis...The present study aimed to examine the effectiveness of bi-level positive airway pressure(BiPAP)versus continuous positive airway pressure(CPAP)in preterm infants with birth weight less than 1500 g and respiratory distress syndrome(RDS)following intubation-surfactant-extubation(INSURE)treatment.A two-center randomized control trial was performed.The primary outcome was the reintubation rate of infants within 72 h of age after INSURE.Secondary outcomes included bronchopulmonary dysplasia(BPD),necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP)and incidences of adverse events.Lung function at one year of corrected age was also compared between the two groups.There were 140 cases in the CPAP group and 144 in the BiPAP group.After INSURE,the reintubation rates of infants within 72 h of age were 15%and 11.1%in the CPAP group and the BiPAP group,respectively(P>0.05).Neonates in the BiPAP group was on positive airway pressure(PAP)therapy three days less than in the CPAP group(12.6 d and 15.3 d,respectively,P<0.05),and on oxygen six days less than in the CPAP group(20.6 d and 26.9 d,respectively,P<0.05).Other outcomes such as BPD,NEC,ROP and feeding intolerance were not significantly different between the two groups(P>0.05).There was no difference in lung function at one year of age between the two groups(P>0.05).In conclusion,after INSURE,the reintubation rate of infants within 72 h of age was comparable between the BiPAP group and the CPAP group.BiPAP was superior to CPAP in terms of shorter durations(days)on PAP support and oxygen supplementation.There were no differences in the incidences of BPD and ROP,and lung function at one year of age between the two ventilation methods.展开更多
Objective:This meta-analysis aims to systematically evaluate the effects of massage on infants with jaundice.Methods:Multiple electronic databases,including Cochrane Library,PubMed,EMBASE,Web of Science,China Biology ...Objective:This meta-analysis aims to systematically evaluate the effects of massage on infants with jaundice.Methods:Multiple electronic databases,including Cochrane Library,PubMed,EMBASE,Web of Science,China Biology Medicine (CBM),Wan Fang Data,VIP Database for Chinese Technical Periodicals and China National Knowledge Infrastructure (CNKI),were used to search for studies on the effects of massage on infants with jaundice.Data were analysed by Rev Man 5.3.Results:A total of 14 randomised controlled trials with 1889 patients were included.Statistically significant difference in percutaneous bilirubin [MD =-1.21,95% CI (-1.90,-0.52),P< 0.05;MD =-2.00,95% CI (-2.68,-1.32),P<0.05;MD=-2.00,95% CI (2.56,-1.44),P<0.05;MD=-1.93,95% CI (-2.44,-1.43),P< 0.05] was found between two groups at 48,72,96 and 168 h.Studies on the serum total bilirubin level were divided into two subgroups according to sample size,and the results of subgroup analysis showed that the serum total bilirubin level in the intervention group was significantly lower than that in the control group [MD =-52.06,95% CI (-57.76,-46.36),P< 0.05 and MD =-10.65,95% CI (-14.66,-6.63),P < 0.05].Statistically significant difference in defecation frequency was observed between the two groups at 48 h after birth[SMD =0.44,95%CI (0.02,0.87),P< 0.05].Conclusion:Massage can decrease serum total bilirubin and percutaneous bilirubin levels and increasing defecation frequency.However,due to heterogeneity among studies,numerous multi-centre,largesample and high-quality randomised controlled trials are needed to verify the effects of massage.展开更多
BACKGROUND Congenital bronchobiliary fistula is a rare developmental abnormality with an abnormal fistula between the respiratory system and biliary tract. The aim of this report is to analyze and summarize the clinic...BACKGROUND Congenital bronchobiliary fistula is a rare developmental abnormality with an abnormal fistula between the respiratory system and biliary tract. The aim of this report is to analyze and summarize the clinical features and experience of diagnosing and treating congenital bronchobiliary fistula(CBBF) occurring in the neonatal period.CASE SUMMARY The onset of symptoms was 3 d after birth in our patient with progressive cyanosis and respiratory distress, and a large amount of green fluid was noticed in her respiratory secretion. We performed computed tomography(CT),fiberoptic bronchoscopy, and cholangiography to make a diagnosis, as well as fistulography with a bronchoscope for the first time. These examinations provided us with valuable images to make a correct diagnosis. The fistula was dissected and removed with excellent results. Surgical removal of the fistula was successful, and the baby recovered well and was discharged. She has been followed for 4 mo without any signs of discomfort.CONCLUSION The main symptom of CBBF is bile-like sputum. CT, bronchoscopy,fistulography, and intraoperative cholangiography can provide important evidence for diagnosis. Surgical resection of the fistula is the first choice of treatment.展开更多
Background: Intra-uterine crowding(IUC) observed in hyperprolific sows impairs myofiber hyperplasia and overall fetal growth. Arginine supplementation(ARG) in gestation diets has been shown to positively affect litter...Background: Intra-uterine crowding(IUC) observed in hyperprolific sows impairs myofiber hyperplasia and overall fetal growth. Arginine supplementation(ARG) in gestation diets has been shown to positively affect litter and muscle development. The study objective was to assess whether the effect of ARG on offspring characteristics, with special emphasis on myofiber hyperplasia, differs under IUC conditions from these responses,because in that situation growth retardation is particularly prevalent due to reduced fetal nutrient supply.Unilateral oviduct ligation(OL) was used as a model for an uncrowded and hyperprolificacy(IN) as a model for a crowded intra-uterine environment.Methods: Five OL and five IN sows were fed a diet supplemented daily with either 43 g L-alanine(Ctrl) or 25 g L-arginine from d 14 to 28 of gestation in a cross-over design(two periods: 5^( th) and 6^( th) parity). At farrowing, two male and two female offspring, respectively, with a low and intermediate birth weight(BtW) were selected. After euthanization, the Semitendinosus muscle(STM) was removed and weighed, and the light and dark portions(STM_d and STM_l) were prepared for myofiber histochemistry using ATPase staining and the entire STM for gene expression analysis of myogenesis-related genes using RT-qPCR. In addition, various organs were removed and weighed. Data were analyzed using the MIXED model in SYSTAT.Results: No effect of either IUC or dietary treatment was found in litter characteristics. Offspring of ARG sows displayed a greater muscle area in STM(P < 0.01) as a result of the greater myofiber hyperplasia(P < 0.01). The increase was more distinct in the STM_l(P < 0.05) than in the STM_d(P = 0.131). Offspring of OL sows were heavier at birth(P < 0.01), had a heavier STM(P < 0.05), liver(P < 0.01) and kidney(P < 0.05), but when expressed relative to birth weight, these differences were absent. In addition, IUC had an effect(P < 0.05) on the expression of one of the myogenesis-related genes investigated.Conclusions: Independent from the extent of IUC, ARG improved Bt W, muscle and organ weights and myofiber hyperplasia in offspring.展开更多
Background： The rapid gain in lean mass in neonates requires greater rates of protein synthesis than degradation. We previously delineated the molecular mechanisms by which insulin and amino acids, especially leucine...Background： The rapid gain in lean mass in neonates requires greater rates of protein synthesis than degradation. We previously delineated the molecular mechanisms by which insulin and amino acids, especially leucine, modulate skeletal muscle protein synthesis and how this changes with development. In the current study, we identified mechanisms involved in protein degradation regulation. In experiment 1,6- and 26-d-old pigs were studied during 1） euinsulinemic-euglycemic-euaminoacidemic, 2） euinsulinemic-euglycemiohyperaminoacidemic, and 3） hyperinsulinemic-euglycemic-euaminoacidemic clamps for 2 h. In experiment 2, 5-d-old pigs were studied during 1） euinsulinemic-euglycemic-euaminoacidemic-euleucinemic, 2） euinsulinemic-euglycemic-hypoaminoacidemic- hyperleucinemic, and 3） euinsulinemic-euglycemic-euaminoacidemic-hyperleucinemic clamps for 24 h. We determined in muscle indices of ubiquitin-proteasome, i.e., atrogin-1 （MAFbx） and muscle RING-finger protein-1 （MuRF1） and autophagy-lysosome systems, i.e., unc51-1ike kinase 1 （UKL1）, microtubule-associated protein light chain 3 （LC3）, and lysosomal-associated membrane protein 2 （Lamp-2）. For comparison, we measured ribosomal protein 56 （rpS6） and eukaryotic initiation factor 4E （elF4E） activation, components of translation initiation. Results： Abundance of atrogin-1, but not MuRF1, was greater in 26- than 6-d-old pigs and was not affected by insulin, amino acids, or leucine. Abundance of ULK1 and LC3 was higher in younger pigs and not affected by treatment. The LC3-11/LC3-1 ratio was reduced and ULK1 phosphorylation increased by insulin, amino acids, and leucine. These responses were more profound in younger pigs. Abundance of Lamp-2 was not affected by treatment or development. Abundance of elF4E, but not rpS6, was higher in 6- than 26-d-old-pigs but unaffected by treatment. Phosphorylation of elF4E was not affected by treatment, however, insulin, amino acids, and leucine stimulated rpS6 phosphorylation, and the responses decreased with development.展开更多
To evaluate the changes of 3', 5'-cyclic adenosine monophosphate (cAMP), thrombox-ane A2(TXA2) and prostacyclin (PGI2) in cerebrospinal fluid (CSF) in the asphyxiated newborn and explore their roles in hypoxic...To evaluate the changes of 3', 5'-cyclic adenosine monophosphate (cAMP), thrombox-ane A2(TXA2) and prostacyclin (PGI2) in cerebrospinal fluid (CSF) in the asphyxiated newborn and explore their roles in hypoxic-ischamic brain damage (HIBD). Thirty-six full term newborns were divided into 3 groups, including 12 with moderate-severe hypoxic-ischaemic encephalopathy (HIE), 13 with mild HIE, 11 without HIE (control group). The levels of cAMP, TXB2(TXA2 metabolite) and 6-keto-PGF1α(PGI2 metabolite) in CSF and plasma were measured 36-72 h after birth by RIA, and the concentrations were expressed as nM/L (cAMP), ng/L(TXB2 and 6-keto-PGF1α). The infants were followed-up at 6 and 12 month of age and Mental Development Index (MDI) and Psychomotor Development Index (FDD were measured using Bayley Scales of Infant Development (BSID). The CSF cAMP level in moderate-severe HIE group was 8. 60±2. 40, significantly lower than that of the mild HIE group (14. 83±2. 84) and the control group (24. 43±2. 39)(for both P<0. 01). The levels of TXB2 and 6-keto-PGF1α in CFS in the moderate-severe HIE group (206. 06±29. 74, 168. 47± 23. 02, respectively) were significantly higher than in the mild HIE group (83. 37±28. 57, 131. 42± 16. 57, respectively, P<0. 01) and the control group (41. 77±21. 58, 86. 23±13. 05, respectively, P<0. 01). The level changes of cAMP,TXB2 and 6-keto-PGF1α in plasma in all groups were similar to those in CSF, but no significant difference was found between mild HIE group and the control group (P>0. 05). The follow-up results showed that MDI and PDI of the moderate-severe HIE group were the lowest (84. 79±13. 34, 83. 50±13. 28, respectively), followed by mild HIE group (102.19±7. 02, 99. 94±9. 08, respectively) , with the control group being the highest (116. 63± 12.08, 116. 69±10. 87, respectively). Univariate analysis showed some significant difference (the moderate-severe HIE group vs. the mild HIE group or the control group, P<0. 01; the mild HIE group vs. the control group P<0. 05). The results suggested that the concentration of cAMP, TXA2 and T/K ratio in CSF after neonatal asphyxia might be sensitive markers in evaluating the severity of brain damage in early stage and predicting the future outcome.展开更多
Circadian rhythm disorder is a common,but often neglected,consequence of neonatal hypoxic-ischemic brain damage(HIBD).However,the underlying molecular mechanisms remain largely unknown.We previously showed that,in a r...Circadian rhythm disorder is a common,but often neglected,consequence of neonatal hypoxic-ischemic brain damage(HIBD).However,the underlying molecular mechanisms remain largely unknown.We previously showed that,in a rat model of HIBD,up-regulation of microRNA-325(miR-325)in the pineal gland is responsible for the suppression of Aanat,a key enzyme involved in melatonin synthesis and circadian rhythm regulation.To better understand the mechanism by which miR-325 affects circadian rhythms in neonates with HIBD,we compared clinical samples from neonates with HIBD and samples from healthy neonates recruited from the First Affiliated Hospital of Soochow University(Dushuhu Branch)in 2019.We found that circulating miR-325 levels correlated positively with the severity of sleep and circadian rhythm disorders in neonates with HIBD.Furthermore,a luciferase reporter gene assay revealed that LIM homeobox 3(LHX3)is a novel downstream target of miR-325.In addition,in miR-325 knock-down mice,the transcription factor LHX3 exhibited an miR-325-dependent circadian pattern of expression in the pineal gland.We established a neonatal mouse model of HIBD by performing doublelayer ligation of the left common carotid artery and exposing the pups to a low-oxygen environment for 2 hours.Lhx3 mRNA expression was significantly down-regulated in these mice and partially rescued in miR-325 knockout mice subjected to the same conditions.Finally,we showed that improvement in circadian rhythm-related behaviors in animals with HIBD was dependent on both miR-325 and LHX3.Taken together,our findings suggest that the miR-325-LHX3 axis is responsible for regulating circadian rhythms and provide novel insights into the identification of potential therapeutic targets for circadian rhythm disorders in patients with neonatal HIBD.The clinical trial was approved by Institutional Review Board of Children’s Hospital of Soochow University(approval No.2015028)on July 20,2015.Animal experiments were approved by Animal Care and Use Committee,School of Medicine,Soochow University,China(approval No.XD-2016-1)on January 15,2016.展开更多
Mild encephalopathy/encephalitis with a reversible splenial(MERS) lesion is a clinic-radiological entity. The clinical features of MERS in neonates are still not systemically reported. This paper presents five cases o...Mild encephalopathy/encephalitis with a reversible splenial(MERS) lesion is a clinic-radiological entity. The clinical features of MERS in neonates are still not systemically reported. This paper presents five cases of MERS, and the up-to-date reviews of previously reported cases were collected and analyzed in the literature. Here we describe five cases clinically diagnosed with MERS. All of them were neonates and the average age was about 4 days. They were admitted for the common neurological symptoms such as hyperspasmia, poor reactivity and delirium. Auxiliary examinations during hospitalization also exhibited features in common. In this report, we reached following conclusions. Firstly, magnetic resonance imaging revealed solitary or comprehensive lesions in the splenium of corpus callosum, some of them extending to almost the whole corpus callosum. The lesions showed low intensity signal on T1-weighted images, homogeneously hyperintense signal on T2-weighted images, fluid-attenuated inversion recovery and diffusion-weighted images, and exhibited an obvious reduced diffusion on apparent diffusion coefficient map. Moreover, the lesions in the magnetic resonance imaging disappeared very quickly even prior to the clinical recovery. Secondly, all the cases depicted here suffered electrolyte disturbances especially hyponatremia which could be easily corrected. Lastly, all of the cases recovered quickly over one week to one month and majority of them exhibited signs of infections and normal electroencephalography.展开更多
To explore the relationship between Insulin-like growth factor (IGF)- Ⅰ, -Ⅱ and lung development in neonatal rats. 80 timed pregnant Sprague-Dawley ( SD) rats were randomly divided into 4 groups (n=20): group A (Con...To explore the relationship between Insulin-like growth factor (IGF)- Ⅰ, -Ⅱ and lung development in neonatal rats. 80 timed pregnant Sprague-Dawley ( SD) rats were randomly divided into 4 groups (n=20): group A (Control group), group B (Dexamethasone (DEX) 1 group), group C (DEX 2 group), group D (retinoic acid (RA) group). 20 pregnant rats in group A, B and D were injected subcutaneously or intraperitoneally with vehicle (NS), DEX, or RA respectively during gestational day 16 to 18. All newborn rats in group C were subcutaneously injected with DEX at day 1 to 3 after birth. The lung tissue was obtained at the following times: fetuses at gestational ages of 18, 20 and 21 days, and 1, 3, 5, 7, 10, 14 and 21 days after birth. Lung tissues were used for histopathological study, the polypeptides analysis of IGF-Ⅰ, -Ⅱ (immunohistochemistry and Western blot) and mRNA analysis ( RT- PCR). The results showed that the strongest expression of IGF-Ⅰ in group A and D occurred at ages of 5-7 days (alveolar stage). The stronger their expressions, the better the alveolar develop. The peak stage of expression in group B occurred earlier, on the day 3 after birth. Compared with group A, the expression of IGF-Ⅰ during gestation age of 18 days to age of 3 days in group B were significantly higher (P<0.01), but significantly lower at other time points (P<0.01). The expression of IGF-Ⅰ was lower in group C all the time and always higher in group D than those in group A (P<0.01). The peak expression of IGF-Ⅱ took place at the gestation age of 18 days, then gradually dropped to trace. During 18 days of gestation to age of 3 days, the expression of IGF-Ⅱ in group B was significantly higher than that in group A (P<0.01). No difference was found among all other groups. The change in the expression of IGF-Ⅰ, -Ⅱ mRNA in all 4 groups was similar to that of their polypeptides. The results suggested that there is a close linking between IGF-Ⅰ, -Ⅱ and lung development in newborns. The IGF-Ⅱ works at early stage and the that of IGF-Ⅰ works at the stage of new septa formation and alveoli maturation. The stronger their expressions, the more mature the lung development.展开更多
Although hypothermia therapy is effective to treat neonatal hypoxic-ischemic encephalopathy,many neonatal patients die or suffer from severe neurological dysfunction.Erythropoietin is considered one of the most promis...Although hypothermia therapy is effective to treat neonatal hypoxic-ischemic encephalopathy,many neonatal patients die or suffer from severe neurological dysfunction.Erythropoietin is considered one of the most promising neuroprotective agents.We hypothesized that erythropoietin combined with hypothermia will improve efficacy of neonatal hypoxic-ischemic encephalopathy treatment.In this study,41 neonates with moderate/severe hypoxic-ischemic encephalopathy were randomly divided into a control group（hypothermia alone for 72 hours,n = 20） and erythropoietin group（hypothermia ＋ erythropoietin 200 IU/kg for 10 days,n = 21）.Our results show that compared with the control group,serum tau protein levels were lower and neonatal behavioral neurological assessment scores higher in the erythropoietin group at 8 and 12 days.However,neurodevelopmental outcome was similar between the two groups at 9 months of age.These findings suggest that erythropoietin combined with hypothermia reduces serum tau protein levels and improves neonatal behavioral neurology outcome but does not affect long-term neurodevelopmental outcome.展开更多
文摘Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using a self-administered questionnaire.Multiple logistic regression was conducted to test the associated factors with the dependent variables.Results:Only 9.3%of participants had a standardized level of knowledge,while 68.9%reported adequate skills for neonatal resuscitation.Factors associated with a standardized level of knowledge were age(p=0.001)and supportive supervision(p=0.007).Factors associated with the standardized practice level were the presence of hospital guidelines(p=0.028),previous training of nurses(p=0.011),and the presence of supportive supervision(p<0.001).Conclusions:The majority of emergency nurses in Hebron hospitals demonstrated a substandard level of knowledge of neonatal resuscitation.However,most of those nurses surprisingly reported a standardized practice level.The presence of hospital guidelines,training programs,or direct supervision for nurses are factors that can be considered to improve both knowledge and practice toward neonatal resuscitation among emergency nurses in Hebron.
文摘Breast milk represents the gold standard for neonatal nutrition,especially for preterm and term infants with a low birthweight.This awareness is based not only on the nutritional properties of human milk,which is specifically designed for the growth of humans but also on breast milk’s non-nutritional properties,such as protection against infection.In fact,breast milk should be considered a heterogeneous ecosystem,including a wide range of cells in addition to those involved in immune function;growth factors,such as vascular endothelial growth factor;multiple noncoding microRNAs;immune cells;epithelial cells and multipotent mesenchymal stem cells.This recent identification of a pool of progenitor stem cells in human milk is the driving force behind the growing research aimed at identifying the nature of these stem/progenitor cells and their sources.
文摘BACKGROUND Congenital hypothyroidism(CH)is a prevalent childhood endocrine disorder associated with irreversible neurological consequences.Its global incidence is on the rise.AIM To estimate CH incidence in Jordan and assess the potential utility of incorporating(fT4)measurements into the screening process.METHODS This retrospective analysis examined thyroid function test results for infants born at our center between 2016 and 2020.Infants born before 28 weeks and those screened after 14 days of life were excluded.Screening occurred between days 3 and 7 of life,and thyroid-stimulating hormone(TSH)and T4 levels were measured concurrently from peripheral venipuncture blood samples.A TSH cutoff of<5 mIU/L was considered normal.Values between 5 and 20 mIU/L were equivocal,requiring repeat tests.TSH levels exceeding 20 mIU/L were considered critical.RESULTS A total of 10521 infants were included in the study,and 26 were diagnosed with CH,yielding an incidence of 1 in 400 live births.Females constituted 57.7%of CH cases.All CH cases had initial TSH values exceeding 5.0 mIU/L,with clustering above 20 mIU/L.Six CH infants had Down syndrome,accounting for 23.1%of CH cases.CONCLUSION Our study revealed a high incidence of CH in Jordan,marking a significant increase from previously reported rates.We recommend a national study to investigate risk factors and underlying causes of CH in our population.Furthermore,we advocate for the use of TSH alone with a cutoff value of<5 mIU/L for screening purposes.
文摘Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to the Yichang Central People’s Hospital from January 2023 to December 2024 were selected as study subjects based on the inclusion and exclusion criteria,and all subjects underwent bedside craniocerebral ultrasonography and MRI,and the results of MRI were used as the gold standard to divide the infants into the brain-injury group(n=31)and the no-brain-injury The children were divided into brain injury group(n=31)and no brain injury group(n=97),and the value of bedside cranial ultrasonography for early diagnosis of brain tissue injury in neonates with intrauterine distress was analyzed.Results:(1)Among the 128 cases of intrauterine distress neonates,31 cases were examined for abnormal signs,including 22 cases(70.97%)examined by bedside craniocerebral ultrasonography and 28 cases(90.32%)examined by MRI.(2)Bedside cranial ultrasound detected hypoxic-ischemic encephalopathy in 6 cases,accounting for 4.69%,ventricular widening in 2 cases,accounting for 1.56%,intracranial hemorrhage in 8 cases,accounting for 6.25%,periventricular softening of white matter in 5 cases,accounting for 3.91%,and cerebral edema in 1 case,accounting for 0.78%,while MRI detected hypoxic-ischemic encephalopathy in 9 cases,accounting for 7.03%.3 cases of ventricular widening,accounting for 2.34%,4 cases of intracranial hemorrhage,accounting for 3.13%,9 cases of periventricular-intraventricular white matter softening,accounting for 7.03%,and 3 cases of cerebral edema,accounting for 2.34%were examined.Among them,the detection rate of periventricular-intraventricular hemorrhage by bedside cranial ultrasound was significantly higher than that of MRI(P<0.05).Conclusion:The diagnostic value of bedside cranial ultrasound in periventricular-intraventricular hemorrhage is high,but the diagnostic value is not as good as that of MRI in other brain tissue injuries,and clinically appropriate examination protocols can be selected according to the specific types of craniocerebral injuries.
文摘BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system.Truncus arteriosus(TA)is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation,leading to complications such as pulmonary hypertension,heart failure,and severe hypoxia.Although rare individually,the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges,with limited documentation in medical literature.CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1,pre-senting with respiratory distress,cyanosis,and altered spinal curvature.This case demonstrates the complexity of managing neonates with multiple congenital de-fects.Here,the patient was managed with oxygen supplementation,heart failure medication,nasogastric feeding,and multidisciplinary care to optimize her for surgical corrections.A coordinated,interdisciplinary approach was employed to optimize outcomes,particularly in a resource-limited setting.Immediate re-spiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival.CONCLUSION Recognizing co-existing congenital anomalies and their embryological interre-lation is critical in holistic patient care,particularly during neonatal and infancy.
基金Fund supported by the CAMS Innovation Fund for Medical Sciences(CIFMS:2016-12M-3-024)~~
文摘Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1,2014 to December 31,2016.Clinical data(baseline maternal status,preoperative status,perioperative information,maternal and fetal outcomes)of parturients and neonates were collected and analyzed.We summarized the common reasons for applying general anesthesia,and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists(ASA)grade,gestational weeks and intraoperative blood loss,as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study.Among the maternal and fetal factors,pregnancy with internal or surgical diseases is the most common reason(59 cases,60.2%)for choosing GA,followed by the placenta and fetal membrane abnormalities(38 cases,38.8%)and the pregnancy-specific disorders(36 cases,36.7%).ASA gradeⅢ-Ⅳof parturients(χ2=44.3,P<0.05),gestation period<37 weeks(χ2=23.4,P<0.05),and blood loss>800 ml(χ2=5.5,P<0.05)were related to the higher postoperative intensive care unit(ICU)rate in parturients.ASA gradeⅢ-Ⅳof parturients(t=-2.99,P<0.05),gestation period<37 weeks(t=2.47,P<0.05)were related to the longer hospital stay.ASA gradeⅢ-Ⅳof parturients(t=2.21,P=0.01)and gestation period<37 weeks(t=-3.21,P=0.002)were related to the lower one-minute Apgar score of neonates.Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS.High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.
文摘AIM: To determine the etiology and prognostic factors for neonatal gastric perforation(NGP), a rare but life-threatening disease.METHODS: Between 1980 and 2011, nine patients un-derwent surgical intervention for NGP at Seoul National University Children's Hospital. The characteristics and prognosis of the patients were retrospectively analyzed.RESULTS: Among the nine patients, three(33.3%) were preterm babies and five(55.5%) had associated anomalies, which included diaphragmatic eventration(n = 2), congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, and antral web. Three(33.3%) patients were born before 1990 and three(33.3%) had a birth weight < 2500 g. Pneumo-peritoneum was found on preoperative images in six(66.7%) patients, and incidentally in the other three(33.3%) patients. Surgery was performed within 24 h after the onset of symptoms in seven(77.8%) patients. The overall mortality rate was 22.2%(2/9). The time between symptoms and surgical intervention was the only prognostic factor for survival, whereas premature birth and birth weight were not.CONCLUSION: Early detection and advances in neo-natal intensive care may improve the prognosis of NGP.
基金supported by a grant from the University of Hong Kong, China
文摘Lead ion （Pb2＋） has been proven to be a neurotoxin due to its neurotoxicity on mammalian nervous system, especially for the developing brains of juveniles. However, many reported studies involved the negative effects of Pb2＋ on adult neural cells of humans or other mammals, only few of which have examined the effects of Pb2＋ on neural stem cells. The purpose of this study was to reveal the biological effects of Pb2＋from lead acetate [Pb （0H30OO）2] on viability, proliferation and differentiation of neural stem cells derived from the hippocampus of newborn rats aged 7 days and adult rats aged 90 days, respectively. This study was carried out in three parts. In the first part, 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyltetrazolium bromide assay （MTT viability assay） was used to detect the effects of Pb2＋ on the cell viability of passage 2 hippocampal neural stem cells after 48-hour exposure to 0-200 pM Pb2＋. In the second part, 10 pM bromodeoxyuridine was added into the culture medium of passage 2 hippocampal neural stem cells after 48-hour exposure to 0- 200 pM Pb2＋, followed by immunocytochemical staining with anti-bromodeoxyuridine to demonstrate the effects of Pb2＋ on cell proliferation. In the last part, passage 2 hippocampal neural stem cells were allowed to grow in the differentiation medium with 0-200 pM Pb2＋. Immunocytochemical staining with anti-microtubule-associated protein 2 （a neuron marker）, anti-glial fibrillary acidic protein （an astrocyte marker）, and anti-RIP （an oligodendrocyte marker） was performed to detect the differentiation commitment of affected neural stem cells after 6 days. The data showed that Pb2~ inhibited not only the viability and proliferation of rat hippocampal neural stem cells, but also their neuronal and oligodendrocyte differentiation in vitro. Moreover, increased activity of astrocyte differentiation of hippocampal neural stem cells from both newborn and adult rats was observed after exposure to high concentration of lead ion in vitro. These findings suggest that hippocampal neural stem cells of newborn rats were more sensitive than those from adult rats to Pb2＋cytotoxicity.
基金supported by the National Natural Science Foundation of China,Nos.81871408 and 81271631(to XMW)National Science Foundation for Young Scientists of China,No.81801658(to YZ)+1 种基金Outstanding Scientific Fund of Shengjing Hospital,No.201402(to XMW)345 Talent Support Project of Shengjing Hospital,No.30B(to YZ)。
文摘Maintaining glutamate homeostasis after hypoxic ischemia is important for synaptic function and neural cell activity,and regulation of glutamate transport between astrocyte and neuron is one of the important modalities for reducing glutamate accumulation.However,further research is needed to investigate the dynamic changes in and molecular mechanisms of glutamate transport and the effects of glutamate transport on synapses.The aim of this study was to investigate the regulatory mechanisms underlying Notch pathway mediation of glutamate transport and synaptic plasticity.In this study,Yorkshire neonatal pigs(male,age 3 days,weight 1.0–1.5 kg,n=48)were randomly divided into control(sham surgery group)and five hypoxic ischemia subgroups,according to different recovery time,which were then further subdivided into subgroups treated with dimethyl sulfoxide or a Notch pathway inhibitor(N-[N-(3,5-difluorophenacetyl-l-alanyl)]-S-phenylglycine t-butyl ester).Once the model was established,immunohistochemistry,immunofluorescence staining,and western blot analyses of Notch pathway-related proteins,synaptophysin,and glutamate transporter were performed.Moreover,synapse microstructure was observed by transmission electron microscopy.At the early stage(6–12 hours after hypoxic ischemia)of hypoxic ischemic injury,expression of glutamate transporter excitatory amino acid transporter-2 and synaptophysin was downregulated,the number of synaptic vesicles was reduced,and synaptic swelling was observed;at 12–24 hours after hypoxic ischemia,the Notch pathway was activated,excitatory amino acid transporter-2 and synaptophysin expression was increased,and the number of synaptic vesicles was slightly increased.Excitatory amino acid transporter-2 and synaptophysin expression decreased after treatment with the Notch pathway inhibitor.This suggests that glutamate transport in astrocytes-neurons after hypoxic ischemic injury is regulated by the Notch pathway and affects vesicle release and synaptic plasticity through the expression of synaptophysin.
文摘The present study aimed to examine the effectiveness of bi-level positive airway pressure(BiPAP)versus continuous positive airway pressure(CPAP)in preterm infants with birth weight less than 1500 g and respiratory distress syndrome(RDS)following intubation-surfactant-extubation(INSURE)treatment.A two-center randomized control trial was performed.The primary outcome was the reintubation rate of infants within 72 h of age after INSURE.Secondary outcomes included bronchopulmonary dysplasia(BPD),necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP)and incidences of adverse events.Lung function at one year of corrected age was also compared between the two groups.There were 140 cases in the CPAP group and 144 in the BiPAP group.After INSURE,the reintubation rates of infants within 72 h of age were 15%and 11.1%in the CPAP group and the BiPAP group,respectively(P>0.05).Neonates in the BiPAP group was on positive airway pressure(PAP)therapy three days less than in the CPAP group(12.6 d and 15.3 d,respectively,P<0.05),and on oxygen six days less than in the CPAP group(20.6 d and 26.9 d,respectively,P<0.05).Other outcomes such as BPD,NEC,ROP and feeding intolerance were not significantly different between the two groups(P>0.05).There was no difference in lung function at one year of age between the two groups(P>0.05).In conclusion,after INSURE,the reintubation rate of infants within 72 h of age was comparable between the BiPAP group and the CPAP group.BiPAP was superior to CPAP in terms of shorter durations(days)on PAP support and oxygen supplementation.There were no differences in the incidences of BPD and ROP,and lung function at one year of age between the two ventilation methods.
文摘Objective:This meta-analysis aims to systematically evaluate the effects of massage on infants with jaundice.Methods:Multiple electronic databases,including Cochrane Library,PubMed,EMBASE,Web of Science,China Biology Medicine (CBM),Wan Fang Data,VIP Database for Chinese Technical Periodicals and China National Knowledge Infrastructure (CNKI),were used to search for studies on the effects of massage on infants with jaundice.Data were analysed by Rev Man 5.3.Results:A total of 14 randomised controlled trials with 1889 patients were included.Statistically significant difference in percutaneous bilirubin [MD =-1.21,95% CI (-1.90,-0.52),P< 0.05;MD =-2.00,95% CI (-2.68,-1.32),P<0.05;MD=-2.00,95% CI (2.56,-1.44),P<0.05;MD=-1.93,95% CI (-2.44,-1.43),P< 0.05] was found between two groups at 48,72,96 and 168 h.Studies on the serum total bilirubin level were divided into two subgroups according to sample size,and the results of subgroup analysis showed that the serum total bilirubin level in the intervention group was significantly lower than that in the control group [MD =-52.06,95% CI (-57.76,-46.36),P< 0.05 and MD =-10.65,95% CI (-14.66,-6.63),P < 0.05].Statistically significant difference in defecation frequency was observed between the two groups at 48 h after birth[SMD =0.44,95%CI (0.02,0.87),P< 0.05].Conclusion:Massage can decrease serum total bilirubin and percutaneous bilirubin levels and increasing defecation frequency.However,due to heterogeneity among studies,numerous multi-centre,largesample and high-quality randomised controlled trials are needed to verify the effects of massage.
文摘BACKGROUND Congenital bronchobiliary fistula is a rare developmental abnormality with an abnormal fistula between the respiratory system and biliary tract. The aim of this report is to analyze and summarize the clinical features and experience of diagnosing and treating congenital bronchobiliary fistula(CBBF) occurring in the neonatal period.CASE SUMMARY The onset of symptoms was 3 d after birth in our patient with progressive cyanosis and respiratory distress, and a large amount of green fluid was noticed in her respiratory secretion. We performed computed tomography(CT),fiberoptic bronchoscopy, and cholangiography to make a diagnosis, as well as fistulography with a bronchoscope for the first time. These examinations provided us with valuable images to make a correct diagnosis. The fistula was dissected and removed with excellent results. Surgical removal of the fistula was successful, and the baby recovered well and was discharged. She has been followed for 4 mo without any signs of discomfort.CONCLUSION The main symptom of CBBF is bile-like sputum. CT, bronchoscopy,fistulography, and intraoperative cholangiography can provide important evidence for diagnosis. Surgical resection of the fistula is the first choice of treatment.
文摘Background: Intra-uterine crowding(IUC) observed in hyperprolific sows impairs myofiber hyperplasia and overall fetal growth. Arginine supplementation(ARG) in gestation diets has been shown to positively affect litter and muscle development. The study objective was to assess whether the effect of ARG on offspring characteristics, with special emphasis on myofiber hyperplasia, differs under IUC conditions from these responses,because in that situation growth retardation is particularly prevalent due to reduced fetal nutrient supply.Unilateral oviduct ligation(OL) was used as a model for an uncrowded and hyperprolificacy(IN) as a model for a crowded intra-uterine environment.Methods: Five OL and five IN sows were fed a diet supplemented daily with either 43 g L-alanine(Ctrl) or 25 g L-arginine from d 14 to 28 of gestation in a cross-over design(two periods: 5^( th) and 6^( th) parity). At farrowing, two male and two female offspring, respectively, with a low and intermediate birth weight(BtW) were selected. After euthanization, the Semitendinosus muscle(STM) was removed and weighed, and the light and dark portions(STM_d and STM_l) were prepared for myofiber histochemistry using ATPase staining and the entire STM for gene expression analysis of myogenesis-related genes using RT-qPCR. In addition, various organs were removed and weighed. Data were analyzed using the MIXED model in SYSTAT.Results: No effect of either IUC or dietary treatment was found in litter characteristics. Offspring of ARG sows displayed a greater muscle area in STM(P < 0.01) as a result of the greater myofiber hyperplasia(P < 0.01). The increase was more distinct in the STM_l(P < 0.05) than in the STM_d(P = 0.131). Offspring of OL sows were heavier at birth(P < 0.01), had a heavier STM(P < 0.05), liver(P < 0.01) and kidney(P < 0.05), but when expressed relative to birth weight, these differences were absent. In addition, IUC had an effect(P < 0.05) on the expression of one of the myogenesis-related genes investigated.Conclusions: Independent from the extent of IUC, ARG improved Bt W, muscle and organ weights and myofiber hyperplasia in offspring.
基金funded in part by National Institute of Arthritis and Musculoskeletal and Skin Diseases Grant AR-044474(T.A.Davis)National Institute of Child Health and Human Development HD-072891(T.A.Davis)by the USDA/ARS under Cooperative Agreement no.6250-510000-055(T.A.Davis)
文摘Background： The rapid gain in lean mass in neonates requires greater rates of protein synthesis than degradation. We previously delineated the molecular mechanisms by which insulin and amino acids, especially leucine, modulate skeletal muscle protein synthesis and how this changes with development. In the current study, we identified mechanisms involved in protein degradation regulation. In experiment 1,6- and 26-d-old pigs were studied during 1） euinsulinemic-euglycemic-euaminoacidemic, 2） euinsulinemic-euglycemiohyperaminoacidemic, and 3） hyperinsulinemic-euglycemic-euaminoacidemic clamps for 2 h. In experiment 2, 5-d-old pigs were studied during 1） euinsulinemic-euglycemic-euaminoacidemic-euleucinemic, 2） euinsulinemic-euglycemic-hypoaminoacidemic- hyperleucinemic, and 3） euinsulinemic-euglycemic-euaminoacidemic-hyperleucinemic clamps for 24 h. We determined in muscle indices of ubiquitin-proteasome, i.e., atrogin-1 （MAFbx） and muscle RING-finger protein-1 （MuRF1） and autophagy-lysosome systems, i.e., unc51-1ike kinase 1 （UKL1）, microtubule-associated protein light chain 3 （LC3）, and lysosomal-associated membrane protein 2 （Lamp-2）. For comparison, we measured ribosomal protein 56 （rpS6） and eukaryotic initiation factor 4E （elF4E） activation, components of translation initiation. Results： Abundance of atrogin-1, but not MuRF1, was greater in 26- than 6-d-old pigs and was not affected by insulin, amino acids, or leucine. Abundance of ULK1 and LC3 was higher in younger pigs and not affected by treatment. The LC3-11/LC3-1 ratio was reduced and ULK1 phosphorylation increased by insulin, amino acids, and leucine. These responses were more profound in younger pigs. Abundance of Lamp-2 was not affected by treatment or development. Abundance of elF4E, but not rpS6, was higher in 6- than 26-d-old-pigs but unaffected by treatment. Phosphorylation of elF4E was not affected by treatment, however, insulin, amino acids, and leucine stimulated rpS6 phosphorylation, and the responses decreased with development.
文摘To evaluate the changes of 3', 5'-cyclic adenosine monophosphate (cAMP), thrombox-ane A2(TXA2) and prostacyclin (PGI2) in cerebrospinal fluid (CSF) in the asphyxiated newborn and explore their roles in hypoxic-ischamic brain damage (HIBD). Thirty-six full term newborns were divided into 3 groups, including 12 with moderate-severe hypoxic-ischaemic encephalopathy (HIE), 13 with mild HIE, 11 without HIE (control group). The levels of cAMP, TXB2(TXA2 metabolite) and 6-keto-PGF1α(PGI2 metabolite) in CSF and plasma were measured 36-72 h after birth by RIA, and the concentrations were expressed as nM/L (cAMP), ng/L(TXB2 and 6-keto-PGF1α). The infants were followed-up at 6 and 12 month of age and Mental Development Index (MDI) and Psychomotor Development Index (FDD were measured using Bayley Scales of Infant Development (BSID). The CSF cAMP level in moderate-severe HIE group was 8. 60±2. 40, significantly lower than that of the mild HIE group (14. 83±2. 84) and the control group (24. 43±2. 39)(for both P<0. 01). The levels of TXB2 and 6-keto-PGF1α in CFS in the moderate-severe HIE group (206. 06±29. 74, 168. 47± 23. 02, respectively) were significantly higher than in the mild HIE group (83. 37±28. 57, 131. 42± 16. 57, respectively, P<0. 01) and the control group (41. 77±21. 58, 86. 23±13. 05, respectively, P<0. 01). The level changes of cAMP,TXB2 and 6-keto-PGF1α in plasma in all groups were similar to those in CSF, but no significant difference was found between mild HIE group and the control group (P>0. 05). The follow-up results showed that MDI and PDI of the moderate-severe HIE group were the lowest (84. 79±13. 34, 83. 50±13. 28, respectively), followed by mild HIE group (102.19±7. 02, 99. 94±9. 08, respectively) , with the control group being the highest (116. 63± 12.08, 116. 69±10. 87, respectively). Univariate analysis showed some significant difference (the moderate-severe HIE group vs. the mild HIE group or the control group, P<0. 01; the mild HIE group vs. the control group P<0. 05). The results suggested that the concentration of cAMP, TXA2 and T/K ratio in CSF after neonatal asphyxia might be sensitive markers in evaluating the severity of brain damage in early stage and predicting the future outcome.
基金This study was supported by the National Natural Science Foundation of China,Nos.81871193(to XD),81671532(to BS),81771625&81701490(to XF),81801505(to MG)Jiangsu Provincial Medical Youth Talent of China,Nos.QNRC2016763(to XD),QNRC2016758(to LXX),QNRC2016762(to ML)+7 种基金the Science and Technology Project of Suzhou City of China,No.SS201709(to XD)the Natural Science Foundation of Jiangsu Province of China,No.BK20180205(to XD)the Training Program Foundation for Health Talents of Gusu of China,No.GSWS2019049(to XD)the Jiangsu Provincial Key Medical Discipline of China,No.ZDXKA2016013(to XF)the Jiangsu Province Women and Children Health Research Project of China,No.F201750(to LXX)the Pediatric Clinical Center of Suzhou City of China,No.Szzx201504(to XF)Suzhou Industrial Technology Innovation Project of China,No.SYS201765(to LZ)the Project of Suzhou Science,Education and Health and Technology,China,No.KJXW2018018(to ML).
文摘Circadian rhythm disorder is a common,but often neglected,consequence of neonatal hypoxic-ischemic brain damage(HIBD).However,the underlying molecular mechanisms remain largely unknown.We previously showed that,in a rat model of HIBD,up-regulation of microRNA-325(miR-325)in the pineal gland is responsible for the suppression of Aanat,a key enzyme involved in melatonin synthesis and circadian rhythm regulation.To better understand the mechanism by which miR-325 affects circadian rhythms in neonates with HIBD,we compared clinical samples from neonates with HIBD and samples from healthy neonates recruited from the First Affiliated Hospital of Soochow University(Dushuhu Branch)in 2019.We found that circulating miR-325 levels correlated positively with the severity of sleep and circadian rhythm disorders in neonates with HIBD.Furthermore,a luciferase reporter gene assay revealed that LIM homeobox 3(LHX3)is a novel downstream target of miR-325.In addition,in miR-325 knock-down mice,the transcription factor LHX3 exhibited an miR-325-dependent circadian pattern of expression in the pineal gland.We established a neonatal mouse model of HIBD by performing doublelayer ligation of the left common carotid artery and exposing the pups to a low-oxygen environment for 2 hours.Lhx3 mRNA expression was significantly down-regulated in these mice and partially rescued in miR-325 knockout mice subjected to the same conditions.Finally,we showed that improvement in circadian rhythm-related behaviors in animals with HIBD was dependent on both miR-325 and LHX3.Taken together,our findings suggest that the miR-325-LHX3 axis is responsible for regulating circadian rhythms and provide novel insights into the identification of potential therapeutic targets for circadian rhythm disorders in patients with neonatal HIBD.The clinical trial was approved by Institutional Review Board of Children’s Hospital of Soochow University(approval No.2015028)on July 20,2015.Animal experiments were approved by Animal Care and Use Committee,School of Medicine,Soochow University,China(approval No.XD-2016-1)on January 15,2016.
基金supported by Wuhan Clinical Medical Research Center for Children’s Neural Disease(No.2014-160)
文摘Mild encephalopathy/encephalitis with a reversible splenial(MERS) lesion is a clinic-radiological entity. The clinical features of MERS in neonates are still not systemically reported. This paper presents five cases of MERS, and the up-to-date reviews of previously reported cases were collected and analyzed in the literature. Here we describe five cases clinically diagnosed with MERS. All of them were neonates and the average age was about 4 days. They were admitted for the common neurological symptoms such as hyperspasmia, poor reactivity and delirium. Auxiliary examinations during hospitalization also exhibited features in common. In this report, we reached following conclusions. Firstly, magnetic resonance imaging revealed solitary or comprehensive lesions in the splenium of corpus callosum, some of them extending to almost the whole corpus callosum. The lesions showed low intensity signal on T1-weighted images, homogeneously hyperintense signal on T2-weighted images, fluid-attenuated inversion recovery and diffusion-weighted images, and exhibited an obvious reduced diffusion on apparent diffusion coefficient map. Moreover, the lesions in the magnetic resonance imaging disappeared very quickly even prior to the clinical recovery. Secondly, all the cases depicted here suffered electrolyte disturbances especially hyponatremia which could be easily corrected. Lastly, all of the cases recovered quickly over one week to one month and majority of them exhibited signs of infections and normal electroencephalography.
文摘To explore the relationship between Insulin-like growth factor (IGF)- Ⅰ, -Ⅱ and lung development in neonatal rats. 80 timed pregnant Sprague-Dawley ( SD) rats were randomly divided into 4 groups (n=20): group A (Control group), group B (Dexamethasone (DEX) 1 group), group C (DEX 2 group), group D (retinoic acid (RA) group). 20 pregnant rats in group A, B and D were injected subcutaneously or intraperitoneally with vehicle (NS), DEX, or RA respectively during gestational day 16 to 18. All newborn rats in group C were subcutaneously injected with DEX at day 1 to 3 after birth. The lung tissue was obtained at the following times: fetuses at gestational ages of 18, 20 and 21 days, and 1, 3, 5, 7, 10, 14 and 21 days after birth. Lung tissues were used for histopathological study, the polypeptides analysis of IGF-Ⅰ, -Ⅱ (immunohistochemistry and Western blot) and mRNA analysis ( RT- PCR). The results showed that the strongest expression of IGF-Ⅰ in group A and D occurred at ages of 5-7 days (alveolar stage). The stronger their expressions, the better the alveolar develop. The peak stage of expression in group B occurred earlier, on the day 3 after birth. Compared with group A, the expression of IGF-Ⅰ during gestation age of 18 days to age of 3 days in group B were significantly higher (P<0.01), but significantly lower at other time points (P<0.01). The expression of IGF-Ⅰ was lower in group C all the time and always higher in group D than those in group A (P<0.01). The peak expression of IGF-Ⅱ took place at the gestation age of 18 days, then gradually dropped to trace. During 18 days of gestation to age of 3 days, the expression of IGF-Ⅱ in group B was significantly higher than that in group A (P<0.01). No difference was found among all other groups. The change in the expression of IGF-Ⅰ, -Ⅱ mRNA in all 4 groups was similar to that of their polypeptides. The results suggested that there is a close linking between IGF-Ⅰ, -Ⅱ and lung development in newborns. The IGF-Ⅱ works at early stage and the that of IGF-Ⅰ works at the stage of new septa formation and alveoli maturation. The stronger their expressions, the more mature the lung development.
基金supported by a grant from the Health and Family Planning Commission of Hebei Province of China,No.20150033a grant from the Science and Technology Research and Development Project of Handan City of Hebei Province of China,No.152810879-6
文摘Although hypothermia therapy is effective to treat neonatal hypoxic-ischemic encephalopathy,many neonatal patients die or suffer from severe neurological dysfunction.Erythropoietin is considered one of the most promising neuroprotective agents.We hypothesized that erythropoietin combined with hypothermia will improve efficacy of neonatal hypoxic-ischemic encephalopathy treatment.In this study,41 neonates with moderate/severe hypoxic-ischemic encephalopathy were randomly divided into a control group（hypothermia alone for 72 hours,n = 20） and erythropoietin group（hypothermia ＋ erythropoietin 200 IU/kg for 10 days,n = 21）.Our results show that compared with the control group,serum tau protein levels were lower and neonatal behavioral neurological assessment scores higher in the erythropoietin group at 8 and 12 days.However,neurodevelopmental outcome was similar between the two groups at 9 months of age.These findings suggest that erythropoietin combined with hypothermia reduces serum tau protein levels and improves neonatal behavioral neurology outcome but does not affect long-term neurodevelopmental outcome.
