Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study. / ç›é ¸å³ç¾Žæ‰˜å’ªå®šè”åˆå’ªè¾¾å”‘ä»‘åœ¨å„¿ç«¥çº¤ç»´æ”¯æ°”ç®¡é•œæ£€æŸ¥ä¸­çš„å®‰å ¨æ€§å’Œæœ‰æ•ˆæ€§­­å‰çž»æ€§éšæœºå¯¹ç §ç ”究.

OBJECTIVES: To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children. METHODS: A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (n=60) and an observation group (n=58) using a random number table. The observation group received intravenous pumping of dexmedetomidine hydrochloride (2 µg/mL) at 1 µg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by dexmedetomidine hydrochloride pumped intravenously at 0.5-0.7 µg/(kg·h) 10 minutes later to maintain anesthesia. The control group was given intravenous pumping of propofol at 2 mg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by propofol pumped intravenously at 4-6 mg/(kg·h) 10 minutes later to maintain anesthesia. Fiberoptic bronchoscopy was performed after the children were unconscious. Heart rate (HR), respiratory rate, blood oxygen saturation, and mean arterial pressure (MAP) were recorded before inserting the bronchoscope (T0), at the time of inserting the bronchoscope (T1), when the bronchoscope reached the glottis (T2), when the bronchoscope reached the carina (T3), and when the bronchoscope entered the bronchus (T4). The intraoperative peak airway pressure (Ppeak), examination time, degree of sedation, extent of amnesia, incidence of adverse reactions, postoperative awakening time, and postoperative agitation score were also recorded. RESULTS: Compared with the control group, the observation group had significantly decreased MAP at T1 to T4 and HR at T1 to T3 (P<0.05). Compared with that at T0, MAP was significantly increased at T1 to T4 in the control group and at T3 in the observation group (P<0.05). HR was significantly higher at T1 to T3 than at T0 (P<0.05). Compared with the control group, the observation group showed significantly lower intraoperative Ppeak value, incidence of intraoperative adverse reactions, and postoperative agitation score, significantly shorter examination time, and better effects of amnesia and anesthesia (P<0.05). There was no significant difference in the degree of intraoperative sedation and postoperative awakening time between the two groups (P>0.05). CONCLUSIONS: Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.

[Expression profiles of PI3K, NF-κB, and STAT1 in peripheral blood mononuclear cells in children with bronchial asthma].

OBJECTIVE: To study the expression profiles of PI3K, NF-κB, and STAT1 in peripheral blood mononuclear cells (PBMCs) in children with bronchial asthma, as well as their roles in the pathogenesis of asthma. METHODS: Thirty children with acute exacerbation of bronchial asthma were enrolled as the asthma group, and 20 healthy children were enrolled as the control group. RT-PCR and Western blot were used to measure the mRNA and protein expression levels of PI3K, NF-κB, and STAT1 in PBMCs. A spirometer was used to compare the pulmonary function between the two groups. The correlations between the mRNA expression of PI3K, NF-κB, and STAT1 and pulmonary function in children with bronchial asthma were analyzed. RESULTS: The asthma group had significantly higher mRNA and protein expression levels of PI3K, NF-κB, and STAT1 than the control group (P<0.05). Compared with the control group, the asthma group showed significant reductions in pulmonary function indices such as FEV1%, FEV1/FVC, and PEF% (P<0.05). In children with bronchial asthma, the mRNA expression levels of PI3K, NF-κB, and STAT1 were negatively correlated with FEV1%, FEV1/FVC, and PEF% (P<0.05). CONCLUSIONS: The expression levels of PI3K, NF-κB, and STAT1 increase in children with asthma, and are negatively correlated with pulmonary function indices, suggesting that PI3K, NF-κB and STAT1 are involved in the development and progression of bronchial asthma in children.

Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants: a multicenter study / Validação de um nomograma de bilirrubina transcutânea para identificação de hiperbilirrubinemia neonatal em neonatos a termo e pré-termo tardios saudáveis na China: um estudo multicêntrico

OBJECTIVE: to prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants. METHODS: this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia. RESULTS: in the present study, 972 neonates (10.6%) developed significant hyperbilirubinemia. The 40th percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonates above the 95th percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75th percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875. CONCLUSIONS: this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination. .

OBJETIVO: validar de forma prospectiva um nomograma de bilirrubina transcutânea (BTc) para identificar hiperbilirrubinemia grave em neonatos a termo e pré-termo tardios saudáveis na China. MÉTODOS: foi realizado um estudo multicêntrico que incluiu 9174 neonatos a termo e pré-termo tardios saudáveis em oito unidades da China. Foram realizadas dosagens de BTc utilizando um bilirrubinômetro. Os valores de BTc foram traçados em um nomograma de BTc para identificara capacidade de predição de hiperbilirrubinemia significativa. RESULTADOS: 972 recém-nascidos (10,6%) desenvolveram hiperbilirrubinemia significativa. O percentil 40 de nosso nomograma pode identificar todos os recém-nascidos com risco de hiper-bilirrubinemia significativa, porém com baixo valor preditivo positivo (VPP) (18,9%). De 453 recém-nascidos acima do percentil 95, 275 recém-nascidos desenvolveram posteriormente hiperbilirrubinemia significativa, com VPP elevado (60,7%), porém com baixa sensibilidade (28,3%). O percentil de 75 foi altamente específico (81,9%) e moderadamente sensível (79,8%). A área sob a curva (ASC) de nosso nomograma de BTc foi de 0,875. CONCLUSÕES: este estudo validou o nomograma de BTc, que pode ser utilizado para prever hiperbilirrubinemia significativa em neonatos a termo e pré-termo tardios saudáveis na China. Contudo, combinar o nomograma de BTc e fatores de risco clínicos pode melhorar a precisãode predição da hiperbilirrubinemia grave, o que não foi avaliado neste estudo. São necessários estudos adicionais para confirmar essa combinação. .

Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants: a multicenter study.

OBJECTIVE: to prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants. METHODS: this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia. RESULTS: in the present study, 972 neonates (10.6%) developed significant hyperbilirubinemia. The 40(th) percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonates above the 95(th) percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75(th) percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875. CONCLUSIONS: this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination.

Polymorphic variants of SLCO1B1 in neonatal hyperbilirubinemia in China.

BACKGROUND: To evaluate the association between the genetic polymorphism of the solute carrier organic anion transporter family member 1B1 (SLCO1B1, also known as organic anion transport polypeptide C) and hyperbilirubinemia in Chinese neonates. METHODS: 183 infants with hyperbilirubinemia and 192 control subjects from the Fifth People's Hospital of Shenzhen were recruited. Polymerase chain reaction, restriction fragment length polymorphisms and agarose gel electrophoresis techniques were used to detect genetic variants of SLCO1B1. RESULTS: The study revealed that SLCO1B1 388 G > A occurred significantly more frequently in neonates with hyperbilirubinemia than in controls (RR = 1.50; 95% CI: 1.13-2.00). There were no significant differences in SLCO1B1 521 T > C between the hyperbilirubinemia and the control group (RR, 1.00; 95% CI, 0.72-1.40). No carriage of the C to A substitution at nucleotide 463 was detected. CONCLUSION: The SLCO1B1 388 G > A variant is associated with neonatal hyperbilirubinemia in Chinese neonates.

Impacto dos polimorfismos genéticos SLCO1B1 sobre a hiperbilirrubinemia neonatal: revisão sistemática com metanálise / The impact of SLCO1B1 genetic polymorphisms on neonatal hyperbilirubinemia: a systematic review with meta-analysis

OBJETIVO: Determinar se três variantes (388 G>A, 521 T>C, 463 C>A) do membro 1B1 da família de transportadores de ânions orgânicos portadores de solutos (SLCO1B1) se associam à hiperbilirrubinemia neonatal. FONTE DE DADOS: Foi realizada busca na Infraestrutura do Conhecimento Nacional da China e em MEDLINE. A revisão sistemática com metanálise incluiu estudos genéticos que avaliaram a associação entre hiperbilirrubinemia neonatal e as variantes 388 G>A, 521 T>C, 463 C>A de SLCO1B1 entre janeiro de 1980 e dezembro de 2012. Foi realizada seleção e extração de dados por dois analistas, de forma independente. SUMÁRIO DOS ACHADOS: Foram incluídos dez artigos no estudo. Os resultados revelaram que SLCO1B1 388 G>A se associa a um aumento do risco de hiperbilirrubinemia neonatal (OR< 1,39; IC 95%: 1,07 a 1,82) em recém-nascidos chineses, mas não em recém-nascidos caucasianos, tailandeses, latino-americanos ou malaios. A mutação SLCO1B1 521 T>C mostrou baixo risco de hiperbilirrubinemia neonatal em recém-nascido chineses, e não foram encontradas associações importantes no Brasil nem em recém-nascidos caucasianos, asiáticos, tailandeses e malaios. Não houve diferenças significativas da SLCO1B1 463 C>A entre o grupo com hiperbilirrubinemia e o grupo controle. CONCLUSÃO: O estudo mostrou que a mutação 388 G>A do gene SLCO1B1 é fator de risco para desenvolver hiperbilirrubinemia neonatal em recém-nascidos chineses, mas não em populações caucasianas, tailandesas, brasileiras ou malaias; a mutação SLCO1B1 521 T>C fornece proteção de hiperbilirrubinemia neonatal em recém-nascidos chineses, mas não nas populações caucasianas, tailandesas, brasileiras ou malaias.

OBJECTIVE: To determine whether three variants (388 G>A, 521 T>C, and 463 C>A) of the solute carrier organic anion transporter family member 1B1 (SLCO1B1) are associated with neonatal hyperbilirubinemia. DATA SOURCE: The China National Knowledge Infrastructure and MEDLINE databases were searched. The systematic review with meta-analysis included genetic studies which assessed the association between neonatal hyperbilirubinemia and 388 G>A, 521 T>C, and 463 C>A variants of SLCO1B1 between January of 1980 and December of 2012. Data selection and extraction were performed independently by two reviewers. SUMMARY OF THE FINDINGS: Ten articles were included in the study. The results revealed that SLCO1B1 388 G>A is associated with an increased risk of neonatal hyperbilirubinemia (OR, 1.39; 95% CI, 1.07-1.82) in Chinese neonates, but not in white, Thai, Latin American, or Malaysian neonates. The SLCO1B1 521 T>C mutation showed a low risk of neonatal hyperbilirubinemia in Chinese neonates, while no significant associations were found in Brazilian, white, Asian, Thai, and Malaysian neonates. There were no significant differences in SLCO1B1 463 C>A between the hyperbilirubinemia and the control group. CONCLUSION: This study demonstrated that the 388 G>A mutation of the SLCO1B1 gene is a risk factor for developing neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations; the SLCO1B1 521 T>C mutation provides protection for neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations.

The impact of SLCO1B1 genetic polymorphisms on neonatal hyperbilirubinemia: a systematic review with meta-analysis.

OBJECTIVE: To determine whether three variants (388 G>A, 521 T>C, and 463 C>A) of the solute carrier organic anion transporter family member 1B1 (SLCO1B1) are associated with neonatal hyperbilirubinemia. DATA SOURCE: The China National Knowledge Infrastructure and MEDLINE databases were searched. The systematic review with meta-analysis included genetic studies which assessed the association between neonatal hyperbilirubinemia and 388 G>A, 521 T>C, and 463 C>A variants of SLCO1B1 between January of 1980 and December of 2012. Data selection and extraction were performed independently by two reviewers. SUMMARY OF THE FINDINGS: Ten articles were included in the study. The results revealed that SLCO1B1 388 G>A is associated with an increased risk of neonatal hyperbilirubinemia (OR, 1.39; 95% CI, 1.07-1.82) in Chinese neonates, but not in white, Thai, Latin American, or Malaysian neonates. The SLCO1B1 521 T>C mutation showed a low risk of neonatal hyperbilirubinemia in Chinese neonates, while no significant associations were found in Brazilian, white, Asian, Thai, and Malaysian neonates. There were no significant differences in SLCO1B1 463 C>A between the hyperbilirubinemia and the control group. CONCLUSION: This study demonstrated that the 388 G>A mutation of the SLCO1B1 gene is a risk factor for developing neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations; the SLCO1B1 521 T>C mutation provides protection for neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations.

Association of neonatal hyperbilirubinemia with uridine diphosphate-glucuronosyltransferase 1A1 gene polymorphisms: meta-analysis.

BACKGROUND: Recent reports have suggested that genetic factors, including mutations in the coding region or promoter of uridine diphosphate-glucuronosyltransferase 1A1 (UGT1A1) may increase the risk of development of neonatal hyperbilirubinemia, but the relationship has not been evaluated on systematic review or meta-analysis. METHODS: A meta-analysis of observational studies reporting effect estimates and 95% confidence intervals (95%CI) was conducted on the association between UGT1A1 polymorphisms and neonatal hyperbilirubinemia. RESULTS: A total of 27 eligible studies were identified. In total, 17 studies focused on the association of neonatal hyperbilirubinemia with UGT1A1 Gly71Arg polymorphisms, which indicated that these polymorphisms were associated with an increased risk of neonatal hyperbilirubinemia (A/A+G/A vs G/G: odds ratio [OR], 2.70; P= 0.00; 95%CI: 2.22-3.29; I(2) = 0.0%; P(heterogeneity) = 0.55). Subgroup analyses by ethnicity validated this correlation in Asian, but not in Caucasian, populations (OR, 1.74; P= 0.10; 95%CI: 0.90-3.35; I(2) = 0.00%; P(heterogeneity) = 0.67). Furthermore, 18 studies focused on the association of neonatal hyperbilirubinemia with UGT1A1 TATA promoter polymorphisms. These studies concluded that TATA promoter variants were not associated with an increased risk of neonatal hyperbilirubinemia (7/7 + 6/7 vs 6/6: OR, 1.13; P= 0.23; 95%CI: 0.93-1.37; I(2) = 80.0%; P(heterogeneity) = 0.00). CONCLUSION: UGT1A1 Gly71Arg polymorphisms are a risk factor for developing neonatal hyperbilirubinemia in Asian, but not Caucasian, subjects. UGT1A1 TATA promoter polymorphisms were not associated with an increased risk of neonatal hyperbilirubinemia in Asian subjects, but results from the Caucasian population were conflicting and require further epidemiological investigation.

Neonatal hyperbilirubinemia and Gly71Arg mutation of UGT1A1 gene: a Chinese case-control study followed by systematic review of existing evidence.

AIM: To determine whether the UDP-glucuronosyltransferase 1A1 gene (UGT1A1) Gly71Arg (211G>A) mutation is associated with neonatal hyperbilirubinemia. METHODS: The study consisted of two parts. The case-control study included 112 hyperbilirubinemic infants and 105 control subjects from the Fifth People's Hospital of Shenzhen. Polymerase chain reaction, restriction fragment length polymorphisms and agarose gel electrophoresis techniques were used to detect the UGT1A1 211G>A mutation. Meta-analyses was performed to assess the association between neonatal hyperbilirubinemia and UGT1A1 211G>A. RESULTS: Our case-control study revealed that the likelihood of developing neonatal hyperbilirubinemia was 2.65 times higher in the infants with the A allele in the UGT1A1 211G>A than in the infants with the G allele (95% CI, 1.60-4.39). Meta-analyses (including data from our study) revealed that UGT1A1 211G>A is associated with an increased risk of neonatal hyperbilirubinemia [odds ratio (OR), 2.37; 95% CI, 2.05-2.74]. In the subgroup analyses based on ethnicity, significantly elevated risks were found in Asian populations (OR, 2.45; 95% CI, 2.10-2.84), but no significant associations were present in Caucasian populations (OR, 1.54; 95% CI, 0.87-2.75). CONCLUSION: The UGT1A1 211G>A mutation is associated with neonatal hyperbilirubinemia in Asians, but not in Caucasians.

The accuracy of the procalcitonin test for the diagnosis of neonatal sepsis: a meta-analysis.

A meta-analysis was performed to assess the accuracy of the procalcitonin (PCT) test for diagnosing neonatal sepsis. The major databases, MEDLINE, EMBASE and the Cochrane Library were searched for studies published between January 1996 and May 2009 that evaluated PCT as a diagnostic marker for neonatal sepsis and provided sufficient data to calculate sensitivity and specificity. Twenty-two studies were included in the analysis. Trials that evaluated the PCT test for the diagnosis of early-onset neonatal sepsis at different time points (birth, 0-12 h, 12-24 h, and 24-48 h) and late-onset neonatal sepsis (LONS) all showed moderate accuracy (Q* = 0.79, 0.86, 0.81, 0.82, and 0.77, respectively). The PCT test was more accurate than the C-reactive protein (CRP) test for the diagnosis of LONS. A sensitivity analysis found that differences in PCT assay producer, gestational age and severity of sepsis in the study population may partially explain the between-studies heterogeneity. The PCT test showed moderate accuracy in diagnosing neonatal sepsis, regardless of differences in diagnostic criteria and time points for testing. For the diagnosis of LONS, the PCT test showed better accuracy than the CRP test. PCT is a valuable additional tool for the diagnosis of neonatal sepsis.

[Role of cerebral computed tomography in the evaluation of brain injury following hypoxia in neonates].

OBJECTIVE: To investigate the role of cerebral computed tomography (CT) in the evaluation of the severity of brain injury following hypoxia in neonates. METHODS: A total of 114 full-term newborns who had perinatal hypoxia, including 25 cases of hypoxic-ischemic encephalopathy (HIE), 36 cases of neonatal asphyxia and 53 cases of simple intrauterine fetal distress, were enrolled in this study. Twenty normal newborns served as the Control group. All had cerebral CT scan at 2-7 days of age. Neonatal behavior neurological assessment (NBNA) was performed at 5 days of age. RESULTS: The average NBNA scores were significantly lower and the abnormality rate of NBNA was significantly higher in the HIE group than in the other three groups (P < 0.05). The Asphyxia and the Distress groups had also lower NBNA scores and higher abnormality rate of NBNA than the Control group (P < 0.05). Twenty-two patients were found to have cerebral CT abnormality in the HIE group, but there was only 1 case in the Control group (P < 0.01). The abnormality rate of cerebral CT in the Asphyxia and the Distress groups was not statistically different from that of the Control group. Twenty-five cases of HIE were divided into mild (n=15), medium (n=6) and severe (n=4) by clinical grading but were divided into normal (n=3), mild (n=10), medium (n=7) and severe (n=5) by CT grading. CT and clinical grading on HIE was not consistent. The sensitivity of CT in the diagnosis of mild, moderate and severe HIE was 47%, 33% and 50% respectively, the specificity was 70%, 74% and 86% respectively and the accuracy was 48%, 64% and 80% respectively. CONCLUSIONS: CT evaluation on mild brain injury induced by asphyxia or intrauterine fetal distress is not of any value and the role of CT evaluation on the HIE grade is uncertain and doubtful.