Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia: a multicenter retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.@*METHODS@#This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years.@*RESULTS@#A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group.@*CONCLUSIONS@#In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.

A clinical study on the effects of exchange transfusion and intensive phototherapy on neurodevelopment in neonates with severe hyperbilirubinemia / 中国新生儿科杂志

Objective To study the effects of exchange transfusion(ET) and intensive phototherapy (IPT) on neurodevelopment in neonates with severe hyperbilirubinemia reaching ET criteria.Method From January 2015 to March 2016,neonates with severe hyperbilirubinemia reaching ET criteria with gestational age ≥35 weeks,and hospitalized in the Department of Neonatology of our hospital were enrolled in the study.The parents were informed of the risks of acute bilirubin encephalopathy (ABE) and both the advantages and disadvantages of IPT and ET.Based on the different choices of their parents,the neonates were assigned into the ET group and the IPT group.General conditions,treatment effects,the incidences of ABE and the prognosis were recorded and analyzed.Result A total of 335 patients were included in this study,147 in the ET group and 188 in the IPT group.Before intervention,the peak of total serum bilirubin (TSB) in ET group (475.8± 100.6 μmol/L) was higher than IPT group (398.3±39.8 μmol/L) (the difference of TSB between two groups was 77.4 μmol/L,P＜0.001),and the incidences of high risk factors such as blood incompatibilities,sepsis,cranial hematoma and intracranial hemorrhage in ET group were higher than IPT group (P＜0.05).Compared with at admission,the incidence of ABE in the ET group increased from 32.0％ to 34.0％ at discharge,mainly due to moderate and severe ABE (the ratio of moderate ABE increased from 2.7％ to 10.2％,and severe ABE increase from 2.7％ to 4.8％).Statistically significant differences existed in the proportion of ABE with different severity at admission and discharge in ET group (P＜0.05),while that in IPT group wasn't statistically significant.241 patients were followed up (follow-up rate 71.9％),with the age ranging from 20 to 36 months.6 cases (5.7％,6/106) in the ET group showed hearing disorder while none (0％,0/135) in the IPT group (P＜0.05).The incidences of neuromotor dyskinesia,language development disorder and spasm in ET group were higher than IPT group(7.5％ vs.3.7％,3.8％ vs.1.5％,4.7％ vs.4.4％,respectively),but the differences weren't statistically significant(P＞ 0.05).No deaths were observed in both groups.Conclusion In neonates with severe hyperbilirubinemia whose TSB exceeding the upper limit of current ET criteria (and within upper limit+5 mg/dl),if the neonates have no risk factors nor clinical symptoms of moderate or severe ABE,only IPT and without ET does not increase the incidence of unfavourable prognosis of central nervous system.

Chronotherapy by Ribozyme Targeted to Telomerase in Nude Mice with a Transplanted Tumor: Model for Human Hepatic Cancer / 航天医学与医学工程

Objective To investigate therapeutic autcomes of using telomerase inhibitors to treat cancer at the presumably most and least opportune circadian stages basing on our earlier study. Methods Twenty-four BALB/C nude mice were synchronized to a regimen of LD12:12 for 4 wk. Hepatic cancer cells (SMMC-7721) were implanted into both flanks of each mouse.Two weeks after transplantation,the hTERT-5'RZ was used to treat the hepatic cancer transplanted into the nude mice daily for two weeks,the injection times being either 9 or 21 HALO.Results The tumorinhibition ratio of mice treated at 21 HALO (65%) was statistically significantly higher than that of mice treated at 9 HALO (48%). Telomerase activity was also reduced to a greater extent in mice treated withhTERT-5'RZ at 21 than at 9 HALO, that was at the time of maximal circadian telomerase activity. Conclusion Injection of ribozyme targeted to telomerase during the tumor's DNA synthesis is associated with a betterinhibition of tumor growth and a better therapeutic outcome in hepaticcancer.