Prevalence of hematologic complications on extracorporeal membranous oxygenation in critically ill pediatric patients: A systematic review and meta-analysis.

OBJECTIVES: Despite advances in Extracorporeal Membranous Oxygenation (ECMO) equipment, hematologic complications remain significant in critically ill children. The aim of this study is to summarize prevalence of hematologic complications for children and neonates. METHODS: MEDLINE, PubMed and Scopus databases were searched focusing on the period from January 01, 2017 to October 01, 2022. The population included critically ill children and neonates with hematologic complications. The review included all aspects of related complications including hemorrhage, thrombosis, and hemolysis. We performed random effects meta-analyses. The primary outcome measure was overall hematologic complications. Secondary outcomes are changes in the prevalence of hemorrhagic complications. Risk of bias of included studies was assessed using the Joanna Briggs Institute checklist. RESULTS: The systematic search identified 37 studies totaling 10,659 critically ill pediatric patients receiving ECMO. The pooled prevalence of hemorrhagic complications, thrombotic complications and hemolysis among pediatric patients requiring ECMO was 43.7 % (95 % CI: 28.6 % to 58.9 %, P < 0.001), 27.6 % (95 % CI: 20.4 % to 34.8 %, P < 0.001), 34.3 % (95 % CI: 22.9 % to 45.7 %, P < 0.001). The prevalence of hemorrhagic complications was represented in descending order: surgical site (21.6 %, 95 % CI: 10.3 % to 32.9 %); cannulation site (20.6 %, 95 % CI: 11.8 % to 29.3 %); intracranial (12.2 %, 95 % CI: 9.5 % to 15.0 %); pulmonary (7.7 %, 95 % CI: 5.9 % to 9.6 %); gastrointestinal (6.0 %, 3.7 % to 8.4 %). For the assessment of thrombotic complications, thrombosis in cannulation site had a higher prevalence (28.5 %, 95 % CI: 22.1 % to 34.9 %), followed by DIC (13.5 %, 95 % CI: 8.7 % to 18.3 %) and intracranial thrombosis (4.5 %, 95 % CI: 1.4 % to 7.6 %). Predictors of increased prevalence of hemorrhagic complications included age (P = 0.017) and VV-ECMO support mode (P = 0.029). CONCLUSIONS: Among critically ill pediatric patients, there was a series of hematologic complications can occur during ECMO support. Physicians should pay special attention to the management and establish appropriate treatment programs to reduce the occurrence of hematologic complications.

Genetic and hosts characterization of hantaviruses in port areas in Hainan Province, P. R. China.

BACKGROUND: Hantaviruses (HVs) are major zoonotic pathogens in China that cause hemorrhagic fever with renal syndrome (HFRS) posing a major threat to people's health. Hainan Province, an island located in Southeast China, is an ideal region for sea ports. The unique tropical monsoon climate in Hainan provides sufficient living conditions for rodents, which help spread HVs and other rodent-borne diseases. In the routine monitoring of hantavirus, there was no evidence that rodents in Hainan carried hantavirus. No patients infected with hantavirus were found in the past. However, the surveillance of HVs-carrying rodents covering the whole territory of Hainan has not stopped. METHODOLOGY/PRINCIPAL FINDINGS: For the monitoring of the prevalence of HVs in rodents and the search for theoretical reference for rodent control and HFRS prevention, a total of 60 rodents from 6 monitoring spots were trapped around main ports in Hainan between 2016 and 2019. HV positive samples were identified by a specific kit and sequenced. The data indicated that seven rodents (Rattus norvegicus) were positive for hantavirus with a positivity rate of 11.67%. Phylogenetic analysis suggested that the two complete sequence strains HN1 and HN4 in this research were highly similar to the sequence strains GZRn36 and GZRn148 isolated in Guangdong Province, and they located in the same phylogenetic tree branch which belongs to S2 subtype. Although the two partial sequences HT1 and HT2 isolated in Xisha Islands belong to S2 subtype according to the phylogenetic tree of L segment, they showed a great nucleotide difference with HN1 and HN4. We also found 13 amino acid variations compared with SEOV 80-39 and 6 amino acid mutations related to epitope, and the variations may reduce the effectiveness of the current HFRS vaccines used in humans. CONCLUSIONS/SIGNIFICANCE: The study indicated HVs carried by rodents found in Hainan Province may be transmitted from Guangdong Province through trading ports and carriage of goods by sea. So it is of great significance to strengthen the surveillance of rodents in port areas especially capture and eliminate rodents on ship. Timely elimination of host animals of hantavirus in port areas is necessary to prevent an outbreak of HVs disease.

Calorie restriction prevents the development of insulin resistance and impaired lipid metabolism in gestational diabetes offspring.

BACKGROUND: Gestational diabetes mellitus (GDM) has long-lasting influence on offspring, which is associated with increased risks of insulin resistance, obesity, and type II diabetes mellitus. Calorie restriction (CR) is one of the most common and available nutritional interventions to prevent obesity and diabetes. We are trying to explore the effect of CR on GDM offspring. METHODS: The streptozotocin was used to stimulate C57BL/6J mice to develop GDM, a number of metabolic characteristics and related protein expressions were determined in GDM offspring that were fed ad-libitum or treated with calorie restriction. RESULTS: CR reduced body weight and glucose levels in GDM offspring. CR modulated the lipid metabolism by decreasing triglyceride and cholesterol levels in plasma. We also found that the effect of CR on insulin sensitivity may involve in signaling pathway through the regulations of phosphatase and tensin homologue deleted on chromosome 10 (PTEN) and protein kinase B (Akt). CONCLUSION: GDM is a high risk factor for GDM offspring to develop insulin resistance, while CR could ameliorate this adverse outcome. Moreover, the specific decrease in PTEN activation and increase in Akt phosphorylation in livers of GDM offspring with CR improved insulin sensitivity and lipid metabolism.

Assessing apoptosis gene expression profiling with a PCR array in the hippocampus of Ts65Dn mice.

It is well known that Down syndrome (DS) is a condition in which extra genetic material causes delays in the way a child develops, both mentally and physically. Intellectual disability is the foremost and most debilitating trait, which caused loss of cognitive abilities and the development of early onset Alzheimer's disease (AD). Ts65Dn mice were used in this study. We isolated the hippocampus. First, we used transmission scanning electron microscopy to directly observe the hippocampus and confirm if apoptosis had occurred. Second, we customized a PCR array with 53 genes, including several important genes related to cell apoptosis. Gene expression was detected by RT-PCR. There were varying degrees of changes characteristic of apoptosis in the hippocampus of Ts65Dn mice, which mainly included the following: nuclear membrane thinning, unevenly distributed chromosomes, the production of chromatin crescents, and pyknosis of the nuclei with some nuclear fragmentation. Meanwhile, three genes (API5, AIFM1, and NFκB1) showed changes of expression in the hippocampus of Ts65Dn mice compared with normal mice. Only NFκB1 expression was significantly increased, while the expressions of API5 and AIFM1 were notably decreased. The fold changes in the expression of API5, AIFM1, and NFκB1 were 11.55, 5.94, and 3.11, respectively. However, some well-known genes related to cell apoptosis, such as the caspase family, Bcl-2, Bad, Bid, Fas, and TNF, did not show changes in expression levels. The genes we found which were differentially expressed in the hippocampus of Ts65Dn mice may be closely related to cell apoptosis. PCR array technology can assist in the screening and identification of genes involved in apoptosis.

Does ceruloplasmin differential express in the brain of Ts65Dn: a mouse mode of Down syndrome?

To investigate the expression of CP in Down syndrome (DS) mouse model, we especially observed the changes in neuronal CP. We systematically analyzed the level of CP in Ts65Dn mouse, including serum CP concentration and enzymatic activity, CP mRNA in brain, the expression of CP protein in brain. The applied technologies were ELISA, chemical colorimetry, RT-PCR, immunohistochemistry. Compared with the control group, there were no differences of significance in the concentration, enzymatic activity and unit activity of serum ceruloplasmin. By RT-PCR, we also found there were no significant differences in the level of CP mRNA. The expression of CP was positive in the endochylema of neuronal cells of both the groups, and there were no significant difference between the two groups. Meanwhile, there were no differences in four regions of the brain (cerebral cortex, hippocampus, thalamus and cerebella). Although the neurotoxic effects of CP related to some neurodegenerative diseases, but whether it does so in DS remains to be determined.

[Prenatal diagnosis of a case with X-linked spondyloepiphyseal dysplasia tarda].

OBJECTIVE: To analyze TRAPPC2 gene mutation in a family with X-linked spondyloepiphyseal dysplasia tarda and to provide genetic counseling and prenatal diagnosis. METHODS: All of 4 exons of the TRAPPC2 gene and their flanking sequences in the proband and her father were analyzed with polymerase chain reaction and direct DNA sequencing. Genomic DNA of the probands' fetus was extracted from amniotic fluid sampled at 18th gestational week. Gender of the fetus was determined by the presence of SRY gene. The sequence of fetal TRAPPC2 gene was also analyzed. RESULTS: A c.209G>A mutation was identified in exon 4 of the TRAPPC2 gene in the proband and her father. The fetus of was determined to be a male and also have carried the c.209G>A mutation. CONCLUSION: A c.209G>A mutation of TRAPPC2 exon 4 probably underlies the clinical manifestations in this family. The proband is a carrier, and her fetus is a male carrying the same mutation. Prenatal diagnosis is an effective method for the prevention of the disease.

[Influence of physical activity on postpartum weight retention among women, one year after childbirth].

OBJECTIVE: To explore the risk factors affecting the postpartum weight retention among women. METHODS: Six hundred eight postpartum women were involved to establish a baseline at 42 days of postpartum in Hefei Maternal and Child Health Center of Anhui province. Information regarding pre-pregnancy weight and weight gain during pregnancy and childbirth were obtained from the Maternal Information Management System. RESULTS: Women that under study were followed up at 3, 6, 9, and 12 months after childbirth, with 502, 476, 469 and 434 available copies of valid data, respectively. Indicators of physical activity were observed. Relationship between postpartum weight retention and physical activities were analyzed by mixed-effect model, together with repeated measure-analysis on related variances. The pre-pregnancy average weight of the study objects was(54.26±8.11)kg, with postpartum average weight retention as(7.83±5.12), (6.58±5.21), (5.10±5.19), (4.07±4.96) and (3.43±4.98) kg in 42 days, 3, 6, 9, 12 months, respectively. Rates of weight retention was significantly different at different times of repeated measures analysis on variance (P < 0.001). Physical activities were also significantly different at different time spans (P < 0.001). Results from the mixed-effects model showed that physical activity and postpartum weight retention were statistically associated when adjustments were made on factors as:pre-pregnancy BMI, ways of feeding, mode of delivery and other confounders (P < 0.001) while results from the mixed-effects model showed that these data were stable from step adjustment on confounding factors. CONCLUSION: It seemed that the strength of physical activity play an important role on postpartum weight retention.

Preliminary proteomic-based identification of a novel protein for Down's syndrome in maternal serum.

Prenatal screening for Down's syndrome (DS) is in need of improvement. As a powerful platform, proteomics techniques could also be used for identification of new biomarkers for DS screening. In this case-control proteome study, pregnant women were diagnosed prenatally by karyotype analysis from amniotic fluid (AF). Maternal serum samples were collected from six pregnancies with fetuses affected by DS and six pregnancies with normal fetuses. First, we used two-dimensional electrophoresis and mass spectrometry to identify the different levels of expression of proteins in maternal serum between the DS and control groups in the second trimester. Second, we used bioinformatics to analyze the proteins by DAVID. Then, the interesting candidates were further tested by enzyme-linked immunosorbent assay (ELISA). Twenty-nine proteins were successfully identified in maternal serum obtained from pregnancies with fetuses affected by DS. The top five proteins up-regulated were serotransferrin (TF), alpha-1b-glycoprotein (A1BG), desmin (DES), alpha-1-antitrypsin (SERPINA1) and ceruloplasmin (CP), while serum amyloid P-component (APCS) was the most down-regulated protein. These 29 proteins were categorized based on binding, catalytic activity and enzyme regulator activity. The biological roles were involved in biological regulation, metabolic processes, cellular processes and response to a stimulus. Based on ELISA, the median concentrations of CP and complement factor B (CFB) were 332.3 and 412.3 ng/mL, respectively. The concentrations of CP and CFB were significantly higher in the DS group than in the control group (P < 0.05). In conclusion, proteomic approaches offer the possibility of further improving the performance of DS screening and our identification of up- and down-regulated proteins may lead to new candidates for DS screening.

Bioinformatics characterization of differential proteins in serum of mothers carrying Down syndrome fetuses: combining bioinformatics and ELISA.

INTRODUCTION: Characterization of novel proteins in maternal serum derived from mothers carrying Down syndrome (DS) fetuses. MATERIAL AND METHODS: Based on last comparative proteomic analysis, five significant differences of expressed proteins in serum from four groups have been confirmed by ELISA. DAVID and GeneGo MetaCore were used to bioinformatically analyze candidate protein markers. RESULTS: The serum levels of ceruloplasmin (CP) and complement factor B (CFB) were significantly increased in mother carried DS fetuses (346.5 ng/ml and 466.8 ng/ml vs. 248.6 ng/ml and 293.5 ng/ml, p< 0.05). Twenty-nine proteins were mainly categorized into binding, catalytic activity and enzyme regulator activity proteins, and their biological roles were involved in biological regulation, metabolic processes, cellular processes, and response to stimuli. The immune response alternative complement pathway was the most significant GeneGo Pathway related to DS. CONCLUSIONS: These 29 proteins have relations with the development of Down syndrome, especially CP and CFB play more important roles.

Assessment of thyroid function during pregnancy: the advantage of self-sequential longitudinal reference intervals.

INTRODUCTION: To evaluate clinical value of a new self-sequential longitudinal reference intervals of thyroid function during pregnancy. MATERIAL AND METHODS: WE ESTABLISHED TWO DIFFERENT SERIES OF REFERENCE INTERVALS: self-sequential longitudinal reference intervals (SLRI) and general gestation-specific reference intervals (GSRI). For SLRI, the serum of 301 cases were collected five times in every case throughout the gestation. For GSRI, A total of 1455 subjects included in the study. We collected the serum respectively at various trimesters. We used TSH of both reference intervals to screen 1744 pregnant women, and compared the percentage of potential misclassification. RESULTS: Both SLRI and GSRI differed substantially from that for non-pregnant women (p < 0.05). There are similar fluctuations of serum TSH, FT4 and TPO-Ab during normal pregnancy. Although there were no significant differences in most reference intervals between SLRI and GSRI. But the IQR of SLRI were usually smaller than GSRI , especially in 1(st) trimester. Two hundred and fifty two women (14.4%) at various trimesters whose serum TSH concentration was within SLRI would be misclassified, while 23 women (1.3%) with a TSH concentration outside limit would not be identified. 0.11-3.84% women would got thyroid diseases during pregnancy. Subclinical hypothyroidism is most common maternal thyroid disorders. CONCLUSIONS: The SLRI can reflected the changes of thyroid function realistically, and can be used to decrease the percentage of potential misclassification of thyroid dysfunction during pregnancy. Screening for thyroid dysfunction of pregnant women is recommended and important.

Establishment of self-sequential longitudinal reference intervals of maternal thyroid function during pregnancy.

The objective of this study is to establish self-sequential longitudinal reference intervals of thyroid function in normal pregnant women. According to the selection criteria, 301 cases were taken as the normal pregnant population to establish a normal reference range. Meanwhile, 150 healthy women were selected as the normal non-pregnant control group. To establish their own self-sequential longitudinal reference intervals, we collected samples five times in every case throughout the gestation (including first trimester, second trimester, third trimester, prenatal and postpartum), and detected the levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibodies (TPO-Ab), and then established the self-sequential longitudinal reference intervals. The levels of TSH, FT4 and TPO-Ab were quantified by electrochemistry immunoassay (ECL) and statistically analyzed using SPSS 13.0 software. Serum TSH of normal pregnant women was at a low level in the first trimester (P < 0.05) and began to rise continuously. Not until prenatal phase was it restored to the non-pregnant state (P > 0.05). During pregnancy, serum FT4 of normal pregnant women were consistently lower than non-pregnant levels (P < 0.05) and kept at low levels. Serum TPO-Ab increased significantly in the third trimester and prenatal phase (P < 0.05). Of normal pregnant women, 6.5% were TPO-Ab positive. In conclusion, the reference intervals in our case will reflect the changes of thyroid function in pregnant women more realistically, resulting in a more accurate value for clinical diagnosis and therapy.

[Analysis on the risk factors of maternal weight for fetal macrosomia].

OBJECTIVE: To investigate the relationship between maternal weight gain and the increasing speed of weight in different pregnant terms and macrosomia. In order to reasonably manage pregnancy and decrease the morbidity of macrosomia. METHODS: 106 newborns whose birth weights were equal to or greater than 4000 g were specified as macrosomia, while 106 newborn with birth weights lying in 2500 - 3999 g were under the control group. A case-control study was conducted to compare the corresponding factors such as maternal BMI, weight before pregnancy and the change of weight during pregnancy respectively. RESULTS: Indicated by both simple and multiple unconditional logistic regression analysis, the cause of fetal macrosomia was mainly associated with the factors including the maternal weight before pregnancy (OR = 2.204, 95%CI: 1.377 - 3.529), maternal weight gain in 12-pregnant weeks (kg per week) (OR = 1.961, 95%CI: 1.204 - 3.194), maternal weight gain in 20-gestation weeks (kg per week) (OR = 1.811, 95%CI: 1.078 - 3.041), maternal weight gain in 30-pregnant weeks (kg per week) (OR = 1.858, 95%CI: 1.095 - 3.153) and virile newborn (OR = 2.630, 95%CI: 1.420 - 4.850. When in 30-pregnant weeks, the pregnant women with 0.5 - 1.0 kg weight gain per week had 1.13 fold risks comparing to those whose weight gains were less than 0.5 kg per week. CONCLUSION: Maternal weight before pregnancy, weight gain during pregnancy and fetal sex appeared a closer relation to macrosomia. It is necessary to monitor the change of maternal weight during different pregnancy periods, especially for the 30th-pregnant weeks.

Absolute radioactivity measurements by the use of a 4pibeta-4pigamma detector configuration.

The radioactivity of 60Co and 134Cs sources were measured using a 4pibeta-4pigamma detector configuration with a well-type NaI(Tl) crystal and a sandwich type 4pibeta detector composed of two sheets of NE102A plastic scintillator coupled to a slender photomultiplier tube. The beta-detector was inserted into the well of the gamma-detector. Since counting efficiencies in both the beta- and gamma-channels can be kept high, excellent counting statistics were attainable even when weak sources were measured. This configuration can also be used for radioactivity measurements based upon the direct integral counting of 4pibeta + 4pigamma logic sum signals, and two independent results can be obtained for every measurement. This technique is especially useful for the standardization of complex decaying nuclides.

Temperature dependence of spurious pulses in use of plastic scintillation detectors.

Pulse-height and time spectra of afterpulses from a scintillation detector with NE102A scintillator sandwiching a 60Co source were observed at several different temperatures. From time analysis with a slow amplifier followed by a conventional TAC, spurious pulses are grouped into two types; time-dependent afterpulses and random noise. The intensity of afterpulses decreased considerably with increasing temperature, while the intensity of random noise pulses increased abruptly above 50 degrees C. Experiments, in which the temperatures of scintillator sheets and of the photomultiplier tube were changed separately, suggested that the time-dependent afterpulses were produced in the scintillator itself, while the random component arose from photomultiplier tube.

Shortening of pulse-width for immediately succeeding trigger signals in the use of logic pulse shapers for nuclear experiments.

If a second succeeding pulse arrives immediately after a first preceding pulse in the output from a non-retrigerable monostable multivibrator, the width of the succeeding pulse is somewhat shortened. Using a time-to-amplitude converter followed by a multi channel analyzer, the pulse-width shortening of the succeeding pulse was measured as a function of the time interval between the two pulses. It was found that this effect was highly dependent on the resistance of an external RC time constant circuit. Similar measurements were also carried out for nuclear instrument modules involving the monostable multivibrator circuits.