Establishment of regional active neonatal transport network / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical function and significance of establishing a regional active neonatal transport network (ANTN) in Beijing.</p><p><b>METHOD</b>The authors retrospectively studied intensive care and the role of ANTN system in management of critically ill neonates and compared the outcome of newborn infants transported to our NICU before and after we established standardized NICU and ANTN system (phase 1: July 2004 to June 2006 vs phase 2: July 2006 to May 2008).</p><p><b>RESULT</b>The number of neonatal transport significantly increased from 587 during phase 1 to 2797 during phase 2. Success rate of transport and the total cure rate in phase 2 were 97.85% and 91.99% respectively, which were significantly higher than those in phase 1 (94.36% and 88.69%, respectively, P < 0.01). The neonatal mortality significantly decreased in phase 2 compared with that in phase 1 (2.29% vs 4.31%, P < 0.01). The capacity of our NICU was enlarged following the development of ANTN. There are 200 beds for level 3 infants in phase 2, but there were only 20 beds in phase 1. Significantly less patients in the phase 2 had hypothermia, acidosis and the blood glucose instability than those in phase 1 (P < 0.01, 0.05, 0.01 and 0.05, respectively). The proportion of preterm infants transported to our NICU were higher in phase 2 compared with that in phase 1, especially infants whose gestational age was below 32 weeks. The proportions of asphyxia and respiratory distress syndrome were lower in phase 2 than that in phase 1, but the total cure rates of these two diseases had no significant changes between the two phases. The most important finding was that the improvement of outcome of premature infants and those with asphyxia and aspiration syndrome was noted following the development of ANTN.</p><p><b>CONCLUSION</b>Establishing regional ANTN for a tertiary hospital is very important to elevate the total level in management of critically ill newborn infants. It plays a very important role in reducing mortality and improving total outcomes of newborn infants. There are still some problems remained to solve after four years practice in order to optimize the ANTN to meet needs of the development of neonatology.</p>

Preliminary study on maturity of retinal vascularization in premature infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the extent of retinal vascular development and influencing factors at birth and the relation between retinal vascularization and retinopathy of prematurity (ROP).</p><p><b>METHODS</b>From October, 2006 to December 2006, retinal vascularization was screened and evaluated in 84 neonates at different weeks of gestation and birth weights (BWs), had dilated fundus evaluation for zone of retinal vascularization by the 130 degrees lens of a digital fundus camera. The infants' pupils were dilated with 2.5% phenylephrine and 0.5% cyclopentolate eye drops. The study cohort was divided into subgroups depending on the weeks of gestation and birth weights. The control group consisted of healthy term infants. Maternal and neonatal factors were ascertained and analysed.</p><p><b>RESULTS</b>Vascularization up to zone I and II was considered to be immature retina; vascularization up to zone III or beyond was considered to be mature retina. In this study, 11 of 12 infants who were born at < 30 weeks of gestation, 12 of 26 infants who were born at < 31 approximately 33 weeks of gestation, 1 of 26 babies who were born at < 34 approximately 36 weeks of gestation and none of 20 babies who were born at < 37-40 weeks of gestation had immature retina; 12 of 15 babies at < 1500 g BW, 8 of 14 infants at 1500 g < BW < 1700 g, 4 of 11 infants at 1700 g < BW < 2000 g and of 44 infants at > 2000 g BW had immature retina. Those infants who were born at > 34 weeks of gestational age and at > 2000 g BW had mature retina. Infants who were born between 31 to 34 weeks of gestation and at 1501 to 2000 g BW had variable extent of retinal vascularization at birth. Vascularization was associated with postconceptional age (F = 31.9193, P = 0.000), birth weight (F = 32.4532, P = 0.000), anemia (F = 36.9391, P = 0.000), surfactant (F = 24.000, P = 0.0000), poor nutrition (F = 4.184, P = 0.041), RDS (F = 17.6191, P = 0.000), cesarean delivery (F = 10.972, P = 0.0022) and oxygen > 48 h (F = 22.076, P = 0.0000). Vascularization was affected mainly by the postconceptional age (95% CI = 1.57-261.728, P = 0.021). At last, 15/24 infants with immature retina developed ROP while none of the infants with mature retina developed ROP (chi2 = 45.1087, P = 0.000).</p><p><b>CONCLUSION</b>There is considerable variability in the extent of retinal vascularization in infants who we born between 31 to 34 weeks of gestation. Modifiable maternal and fetal factors could influence extent of vascularization at birth. Immature retina is the critical factor of ROP. Gestational age is the main factor of the immature retina in premature infants.</p>

Effect of basic fibroblast growth factor on expression of protein and mRNA of bone morphogenetic protein 4 in hypoxic-ischemic brain damage in newborn rats / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of basic fibroblast growth factor(bFGF) on expression of protein and mRNA of bone morphogenetic protein 4 in hypoxic-ischemic brain damage (HIBD) in newborn rats.</p><p><b>METHOD</b>One hundred and twenty 7 days old neonatal rats were randomly divided into control group, hypoxic-ischemic brain damage and interventional group of bFGF, each having forty neonatal rats. After HIBD model was established, bFGF was given to interventional group by peritoneal injection for 5 continuous days. Every group was randomly divided into 7 days, 14 days, 21 days and 28 days group, according to the time of sacrifice. BMP4 protein in hippocampus was determined with immunohistochemical method. Messenger RNA of BMP4 were determined with in situ hybridization. Apoptosis of nerve cell was determined with TUNEL. Intergroup or intragroup comparisons were performed with analysis of variance.</p><p><b>RESULT</b>On the days 7 and 14, expression of BMP4 protein in hippocampus was higher in interventional group of bFGF than in HIBD while expression of BMP4 protein in interventional group of bFGF and HIBD was lower on day 7 than on day 14. Expression of BMP4 protein on the days 21 and 28 had no significant difference among three groups. mRNA expression of BMP4 in interventional group of bFGF and HIBD was significantly higher in hippocampus than in control group. On the day 14, BMP4 mRNA in hippocampus widely expressed in HIBD while BMP4 mRNA only expressed in CA1 in interventional group of bFGF. Expression of BMP4 mRNA in hippocampus on the affected side decreased from the time of killing on 28th day while there was no significant change in interventional group of bFGF. Apoptosis of neural cells at the time of sacrifice on day 7 was lower in interventional group of bFGF than that in HIBD group (F=9.010, P<0.01). Apoptotic neural cells was higher in bFGF and HIBD groups at the time of killing on days 14, 21 and 28 than that on day 7 but that the bFGF group had less apoptotic neural cells than HIBD group (F=9.202, 7.932, 14.985, P<0.01).</p><p><b>CONCLUSIONS</b>bFGF has a neurorestoration effect, which promotes expression of BMP4 protein and BMP4 mRNA in hippocampus of HIBD and inhibit apoptosis of neural cells.</p>

Relationship between reduced expression of surfactant protein B and neonatal respiratory distress syndrome in twenty Han ethnic group neonates in China / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate possible relationship between expression of surfactant protein B (SP-B) gene product and neonatal respiratory distress syndrome (NRDS) in Han ethnic group.</p><p><b>METHOD</b>Unrelated 20 cases with NRDS of Han ethnic group were selected as NRDS group while unrelated 20 diseases cases of Han ethnic group with diseases were selected as control group. The cases in the control group had congenital heart disease or bronchopulmonary dysplasia or persistent pulmonary hypertension. Blood sample was taken from every case. Lung tissues were taken from the patients who died half an hour after death in the two groups. Expression of SP-B in lung tissue was determined with immunohistochemical tecnique. Genetic deficiency variant of SP-B intron IV was screened with polymerase chain reaction (PCR).</p><p><b>RESULTS</b>Two cases at gestational age 26 weeks and one case at gestational age 34 weeks and two cases at gestational age 42 weeks of NRDS groups had lower level expression of SP-B in lung tissue than those at the same age of NRDS. Expression of SP-B in lung tissue of control group increased with gestational age, but no such phenomenon was found in NRDS group. Further, two cases at gestational age 42 weeks of NRDS group had genetic deficiency variant of SP-B intron IV with gene analysis of five cases who had lower expression of SP-B. Clinical data suggest that patients at 42 weeks of gestational age had severe illness.</p><p><b>CONCLUSIONS</b>Decrease of SP-B expression may participate in occurrence of NRDS, genetic deficiency variant of SP-B intron IV exists in the NRDS cases of Han ethnic group of China.</p>

A multivariate analysis of prevalence and risk factors of retinopathy of prematurity / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the prevalence and risk factors of retinopathy of prematurity (ROP).</p><p><b>METHODS</b>This investigation involved 125 premature infants admitted in the neonate intensive unit between July 1st, 2006 and Feb 1st, 2007, who were less than 37 weeks of postconceptional age, or more than 37 weeks but with birth weight <2500 g. At the fourth postnatal week or the corrected gestational age of 32 to 34 weeks, the infants underwent ROP examination of both eyes using RetCam digital retinal camera. Diagnosis and staging of ROP were established according to the international guidelines, with another 20 full-term infants as the control group.</p><p><b>RESULTS</b>All the 125 infants completed the follow up. The prevalence of ROP in the premature group was 6.4%, while no ROP was found in the control group. Of the premature infants, the prevalence of ROP in infants with birth weight </=2000 g (12.7%) was significantly higher than that in those with birth weight more than 2 000 g (0 , %KHgr;(2) =6. 42, P=0.01). In premature infants with postconceptional age </=32 weeks, the prevalence of ROP reached 17.5%, significantly higher than that in infants with postconceptional age over 32 weeks (1.1% , Chi(2)=9.52, P=0.002). The postconceptional age (OR=0.865, P=0.038) and birth weight (OR=0.768, P=0.042) were identified as the most important risk factors for ROP, and correlation was not found between ROP and oxygen inhalation mode, mechanical ventilation, use of indomethacin, or maternal conditions.</p><p><b>CONCLUSIONS</b>The prevalence of ROP is significantly higher in premature infants than in full-term infants, and shorter postconceptional age and lower body weight at birth are associated with increased risk of ROP. Routine examination of the ocular fundus of premature infants on a regular basis can be helpful for early detection of ROP.</p>

Experimental study on growth, proliferation and differentiation of neural stem cell from subventricular zone of human fetal brain at different gestational age / 中华儿科杂志

<p><b>OBJECTIVE</b>To study growth characteristics of neural stem cells (NSCs) from subventricular zone (SVZ) of the different human fetal brain at different gestational age and to provide experimental and theoretical evidences for clinical application of NSCs for treatment of certain diseases.</p><p><b>METHODS</b>Ninety human embryos at gestational age 16 - 36 weeks were collected and were divided into six groups according to gestational age: 16 w, 20 w, 24 w, 28 w, 32 w and 36 w. Each group had 15 embryos and brain tissues were taken from each embryo's SVZ. All subjects had congenital heart disease or digestive tract abnormity diagnosed with B ultrasound at antepartum, but none had abnormal development of brain. Pregnant mother and her husband desire termination of pregnancy. The morphology, existing mode and the number of neural stem cells in subventricular zone were examined with immunohistochemical method. The NSCs in subventricular zone were cultured, passaged and differentiated with cell culture technique, then were identified with immunohistochemical method.</p><p><b>RESULTS</b>NSCs in SVZ from the different human fetal brain existed in a scattered manner in the network formed by stellate cells, NSCs had round, ellipse and fusiform shape, especially in stellate shape. NSCs had larger and smaller size and distributed in dense or scattered forms, each having zero to two enations, most had one or two. NSCs had less cytoplasm. The nucli of the NSCs had a round shape with loose chromatin and 1 - 4 nucleoli. Most of NSCs existed in singular scattered form, some of them showed symmetrical or asymmetrical division, some of them showed synaptic connection with other NSCs. The number of NSCs in SVZ from groups with different fetal age decreased with increasing gestational age (chi(2) = 4644.602, P < 0.01). NSCs in SVZ from the different human fetal brain cultured with serum-free medium formed typical neurospheres in suspension. The cells could be passaged continuously, and could express nestin antigen. Serum-contained medium induced neural stem cells to differentiate and express specific antigens of neuron, astrocyte and oligodendrocyte.</p><p><b>CONCLUSIONS</b>NSCs existed in SVZ of human embryos at different gestational age. There are differences in morphology, existing pattern and the number of NSCs in SVZ at different gestational age. NSCs in SVZ at different gestational age may be cultured in vitro.</p>

Application of Different Experimental Methods for Determining Neural Stem Cells in Hippocampus from Human Fetal Brain / 实用儿科临床杂志

Objective To explore a precise and dependable method for determining neural stem cells(NSCs)in hippocampus from human fetal brain.Methods Ten cases of embryo at gestational age 32 weeks and induction of labor with water bag were collected,affused and sliced including frost slice and paraffin slice for determining alteration of tissue and NSCs in hippocampus from human fetal brain with HE stain and immunohistochemical staining under light microscope.Results Nestin proteins located in NSCs and the number of NSCs were less in paraffin slice of tissue than those in frost slice.Integrality of structure of tissues and cells in paraffin slice excelled in frost slice.Conclusions There is a precise and dependable method including induction of labor with water bag and allusion and frost slice,which is necessary for wide useness in study of NSCs in human fetal brain.

Changes of neural stem cells in neonatal rat model of hypoxic-ischemic encephalopathy / 中华儿科杂志

<p><b>OBJECTIVE</b>To establish a neonatal rat model of hypoxic-ischemic encephalopathy and clarify the changing features of neural stem cells (NSCs) in episodes of hypoxic-ischemic encephalopathy (HIE) so as to provide experimental and theoretical evidences for treating HIE by applying NSCs at the appropraite time.</p><p><b>METHODS</b>Totally 210 neonatal rats aged 7 d were divided randomly into three groups, normal control group, hypoxic group and hypoxic-ischemic group with 70 rats in each. According to the time of sacrefice, 70 rats of every group were further divided randomly into seven groups including third hour (3 h), the sixth hour (6 h), first day (1 d), third day (3 d), the seventh day (7 d), the fourteenth day (14 d) and the twenty-first day (21 d), with 10 rats in each subgroup. The left common carotid artery of the neonatal rats in hypoxic-ischemic group was ligated and those in the hypoxic group were subjected to inhalation of 8% oxygen for 2.5 h. NSCs from brain tissues of the rats of the three groups were determined with HE staining and immunohistochemical method under light microscope.</p><p><b>RESULTS</b>Most of neonatal rats in hypoxic-ischemic group behaved turning to the left stably 1 h after normal concentration of oxygen was given. In hypoxic-ischemic group, slight brain injury occurred at 3 h, severe brain injury appeared at 1 d, glial cells proliferated at 3 d and 7 d, brain atrophy was found at 14 d and 21 d. NSCs existed in brain tissues of rats in all the three groups. NSCs in normal control and the hypoxic group mainly distributed in hippocampus, subventricular tissues, striatum and cortex. But NSCs in hippocampus located in layers of molecule, cone cell and inner granular cell. NSCs in hypoxic-ischemic group showed obvious regional distribution, less in the regions with pathological changes. At 3 h, 6 h and 14 d, there was no difference in the number of NSCs between hypoxi and hypoxic-ischemic group. At 1 d, 3 d and 7 d, there was a highly significant difference in the number of NSCs between hypoxic and hypoxic-ischemic group. At 21 d, there was a significant difference in the number of NSCs between hypoxic and hypoxic-ischemic group, meanwhile, there was a significant difference in the number of NSCs between control and hypoxic group. At 3 d, there was a very significant difference in the number of NSCs between control and hypoxic-ischemic group. At 7 d and 21 d points, there was a highly significant difference in the number of NSCs between control and hypoxic group.</p><p><b>CONCLUSION</b>The neonatal rat model of HIE was successfully established. NSCs increased in earlier period and decreased in later period of HIE, ultimately, NSCs located in the injured regions died one after anotner. Hypoxia induces NSCs' proliferation.</p>

A Simple and Dependable Approach to Establish Hypoxic-Ischemic Encephalopathy Model in Neonatal Rat / 实用儿科临床杂志

Objective To investigate a simple and dependable approach to establish the hypoxic-ischemic encephalopathy model in neonatal rat. Methods Twenty-one neonatal rats of 7 days old were randomly divided into control group,hypoxic group,and hypxic-ischemic group.Every group was randomly divided into 3 hours,6 hours,1 day,3 days,7 days, 14 days,and 21 days group,according to the time of killing.Left common carotid artery of neonatal rats at age of 7 days in hypoxic-ischemic group were ligated.Then,the rats in hypoxic and hypoxic-ischemic group were put in a state of 8% oxygen for 2.5 hours. Brain tissues of rats in 3 groups were observed with HE staining under light microscope.Results In hypoxic-ischemic group,there was found mild brain damage after hypoxic-ischomic 3 hours,the brain lesion was most severe at 1 day,glial cell proliferation was found at 3 days,much neur were losed at 14,21 days,and colloid scar was formed in cortex,striatum and hippocampi.Conclusion The method that left common carotid ontery of neonatal rats were ligated and then put in 8% oxygen for 2.5 hours is simple, rapid and dependable, which can be applied widely.

Changes of Neural Stem Cells in Subventricular in Developing Human Fetal Brain at Different Ages / 实用儿科临床杂志

Objective To observe the changes of neural stem cells(NSCs) in subventricular in developing human fetal brain at(diffe)-rent ages.Methods Thirty cases of embryoes at gestational age 24-28 weeks induced by labor with water bag were collected to determin distribution,shapes and growth modes in subventricular with hybridization in situ under light microscope.Results NSCs expressing Nestin mRNA existed in subventricular from human fetal brain at different ages,NSCs existed in subventricular of different fetal age included astro-NSCs,each had enations from 3 to 6,and all projections crowded together into a reticular plexiform,in which NSCs districuted.Nucli were round in shape,each had nucleoli from 1 to 4.NSCs had rarefaction chromatin,most NSCs existed in a single growth mode,symmetral cleavage growth mode and clony with 3 NSCs would be seen.There were no differences between positive Nestin mRNA NSCs in distribution and cell shapes,but had differences in growth mode.Conclusion NSCs exist in subventricular from different gestational ages and their growth mode are changing with difference of gestational age.

Clinical significance of plasma α1-antichymotrypsin in children with asthma / 第三军医大学学报

Objective　To study the role of α1-antichymotrypsin(α1-ACT)in the pathogenesis of childhood asthma for providing a theoretical base for prevention and treatment of childhood asthma. Methods　Levels of plasma α1-ACT in 30 asthmatic children and 30 healthy children were determined by rocket immunoelectrophoresis. Results　Plasma α1-ACT levels were higher in acute phase than in paroxysmal phase ［（0.4178±0.0815）vs(0.2865±0.0799), t=6.301,P<0.001］ and also higher in asthma group than in control group ［（0.4178±0.0815）vs(0.2876±0.0496),t=7.474,P<0.001］. The plasma α1-ACT levels in asthma group and control of paroxysmal phase were similor ［(0.2865±0.0799) vs (0.2876±0.0496),t=0.064, P>0.05］. The levels of plasma α1-ACT were higher in moderate and heavily attacked patients than that in mild attacked patients ［(0.4553±0.0758) vs (0.3249±0.0926),t=4.187,P<0.001］ and those in control group ［(0.4553±0.0758) vs (0.2865±0.0799),t=9.38,P<0.001］. Conclusion　α1-ACT is involved in pathophysiological course of childhood asthma. Measurement of plasma α1-ACT levels may be helpful in determining the state of the illness and to evaluate the severity and treatment of childhood asthma.

Clinical significance of plasma α1-antichymotrypsin in children with asthma / 第三军医大学学报

Objective　To study the role of α1-antichymotrypsin(α1-ACT)in the pathogenesis of childhood asthma for providing a theoretical base for prevention and treatment of childhood asthma. Methods　Levels of plasma α1-ACT in 30 asthmatic children and 30 healthy children were determined by rocket immunoelectrophoresis. Results　Plasma α1-ACT levels were higher in acute phase than in paroxysmal phase ［（0.4178±0.0815）vs(0.2865±0.0799), t=6.301,P<0.001］ and also higher in asthma group than in control group ［（0.4178±0.0815）vs(0.2876±0.0496),t=7.474,P<0.001］. The plasma α1-ACT levels in asthma group and control of paroxysmal phase were similor ［(0.2865±0.0799) vs (0.2876±0.0496),t=0.064, P>0.05］. The levels of plasma α1-ACT were higher in moderate and heavily attacked patients than that in mild attacked patients ［(0.4553±0.0758) vs (0.3249±0.0926),t=4.187,P<0.001］ and those in control group ［(0.4553±0.0758) vs (0.2865±0.0799),t=9.38,P<0.001］. Conclusion　α1-ACT is involved in pathophysiological course of childhood asthma. Measurement of plasma α1-ACT levels may be helpful in determining the state of the illness and to evaluate the severity and treatment of childhood asthma.

Accumulation of ? Globin mRNA and Induction of Erythroid Differentiation after Treatment of Chronic Myelocytic Leukemia Cell Line K562 with Matrine / 实用儿科临床杂志

Objective To study the effects of matrine on accumulation of ? globin mRNA and induction of erythroid differentiation in K562 cells in vitro.Methods K562 cells were cultured for 6 days with different concentration of matrine,viable cell counts were determined by trypan-blue dye exdusion test. Erythroid differentiation was evaluated by percentage of benzidine-positive cells at different days after culture. Morphological changes were observed under microscope after Wright-Gimesa staining; ? globin mRNA was quantitative by real time quantitative reverse transcript polymerase chain reaction(RT-PCR).Results Different concentrations of matrine inhibited proliferation of K562 cells in dose-dependent manner; otherwise, K562 cells were successfully induced by erythroid differentiation with matrine. After treatment with matrine, percentage of benzidine-positive cells significantly increased from 0.7% to 15.7% and characteristic changes of erythroid differentiation in the cell morphology were observed, G? globin mRNA had a preferential increase (2.7 fold)in K562 cells. Conclusions Matrine accumulation G? globin mRNA and induced erythroid differentiation of K562 cells. The results provides an experimental evidence for the pharmacological therapy of hematological diseases associated with a failure in the expression of normal ? globin genes.

Characters of Culture of Neural Stem Cells from Hippocampus of Neonatal Rats in Different States in Vitro / 实用儿科临床杂志

Objective To investigate the characters of culture of neural stem cells(NSCs) from neonatal rats in different states in vitro.Methods Forty-two neonatal rats at age 7 days were divided randomly into 3 groups as control group,hypoxic group and hypoxic-ischemic group,each having 14 rats.Forteen rats of every group divided randomly into 7 small groups,each including 3 h,6 h,1 d,3 d,(7 d),14 d and 21 d,according to the time to put to death,each having 2 rats.After builting rat models of hypoxic-ischemic encephalopathy,NSCs from hippocampus in 3 groups were isolated,then cultured,passed,differentiated and differentiated with single cell clone and immunocytochemistry tecnique.Results NSCs in hippocampus from 3 groups were cultured in form of typical neuraospheres in suspension.The cells could be cloned,passed continuously and induced.There were differences among 3 groups when primary NSCs were cultured at 3 h and 6 h time points.But at 1 d,3 d,7 d,14 d and 21 d time points,clony neuraospheres from primary NSCs in hypoxic group were the most among 3 groups while clony neuraospheres from primary NSCs in hypoxic-ischemic group were the lest.Conclusions NSCs from hippocampus of neonatal rats in different states remain to be cultured,meanwhile,NSCs are decreased with increase of age,elongation of illness course and progress of state of an illness.