Table of Content

15 September 2017 Volume 35 Issue 9

  

Analysis of the risk factors for blood transfusion in very low birth weight infants

　XU Chuncai, ZHU Jiajun, ZHU Yilin, WU Mingyuan

. 2017, 35(9):  641.  doi:10.3969/j.issn.1000-3606.2017.09.001

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　Objectives　To analyze the risk factors for transfusion in very low birth weight infants and to explore the strategies for prevention of anemia. Methods　Neonates with gestational age <37 weeks and birth weight <1500 g admitted from January 2015 to June 2016 were included. The neonates were divided into blood transfusion group and non-blood transfusion group. The general conditions and complications were compared, and the risk factors of blood transfusion and the related factors were analyzed. Results　One hundred fifty cases of very low birth weight infants were included, among whom 108 cases were from blood transfusion group and 42 cases were from non-blood transfusion group. Compared with the non-blood transfusion group, the gestational age and body weight of the blood transfusion group were smaller, the basic hemoglobin was lower, the parenteral nutrition time was longer, and the total volume of blood collection in hospital was higher, and these differences were all statistically significant (P all<0.05). The incidence of bronchopulmonary dysplasia (BPD), acute respiratory distress syndrome (RDS) and patent ductus arteriosus (PDA) in the blood transfusion group were higher than those in the non-blood transfusion group,  and they were all statistically different (P all <0.05). Multiple linear regression analysis showed that the volume of blood transfusion was higher when the gestational age and body weight were smaller, the longer parenteral nutrition was needed, and the total volume of blood taken from the hospital was higher (P all <0.05). Conclusions　The gestational age, body weight, parenteral nutrition time and the total volume of blood collection in very low birth weight infants have different effects on blood transfusion risk and transfusion volume. The incidences of BPD, RDS, and PDA in infants with blood transfusion are higher.

The effects of optimizing perioperative management strategy on the diagnosis and treatment of congenital diaphragmatic hernia

ZHU Ying, WANG Jun, YANG Zujing, ZHU Jianxing, XIE Lijuan

. 2017, 35(9):  645.  doi:10.3969/j.issn.1000-3606.2017.09.002

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　Objectives　To explore the influence of standardized treatment and technical flow improvement on the diagnosis and treatment of congenital diaphragmatic hernia (CDH) after prenatal diagnosis. Methods　The clinical data of neonates diagnosed with CDH who were hospitalized in neonatal intensive care unit from January 2005 to August 2016 was analyzed retrospectively. Based on the start time of standardized treatment implementation, 93 cases of CDH hospitalized from January 2010 to August 2016 were divided into the intervention group while 15 cases of CDH hospitalized from January 2005 to December 2009 were divided into the control group. The survival rate and complications of clinical outcomes between two groups were compared. Results　There was no significant difference in sex, gestational age, birth weight, Apgar score, and CDH position between two groups (P ＞0.05). The total survival rate was 81.7% in the intervention group and 53.3% in the control group, and there was statistical difference (P＜0.05). The difference of mechanical ventilation mode and pneumothorax rate between two groups also had statistical difference (P ＞0.05). The median operation time in the control group was 4.5 h and the intervention group was 49.5 h. The postoperative survival rate was 61.5% in the control group and 90.5% in the intervention group, and the differences between two groups were significant (P ＞0.05). The first blood gas analysis of deaths cases in both groups showed that there were significant differences in pH and PCO2 values (P ＞0.05). Conclusions　Optimization of the clinical management during perioperative period can improve the survival rate of CDH and reduce complications. However, the dead cases in the intervention group had more severe pulmonary hypoplasia.

Determination of fatty acids in blood, placenta and umbilical cord blood in normal pregnant women

CHEN Aiju， ZHANG Weili，JIN Yanping，HE Jiamin，JIANG Minghua

. 2017, 35(9):  649.  doi:10.3969/j.issn.1000-3606.2017.09.003

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　Objectives　To explore the nutritional status of fatty acids in the newborn and their mother, and the role of the placenta in fetal nutrition. Methods　The composition of fatty acids in blood, placenta, and neonatal umbilical cord blood were determined and analyzed by gas chromatography in 20 normal pregnant women. Results　In 20 pregnant women in the study, average age was 27.0±4.5 years, the average gestational age of their newborns was 38.0±3.0 weeks, the average birth weight of newborns was 3 320±127 g. There were 18 types of fatty acids in maternal blood, umbilical cord and placenta, including saturated fatty acids, monounsaturated fatty acids, and polyunsaturated fatty acids. The total fatty acid content in maternal blood (3.51±0.57 g/L) was 5 times higher than that in umbilical cord blood (0.74±0.18 g/L), and there was statistically difference (P<0.05). The content of linoleic acid (LA) in maternal blood was higher than that in umbilical cord blood and placenta; the content of arachidonic acid (AA) and docosahexenoic acid (DHA) in placenta was significantly higher than that in maternal blood and umbilical cord blood; and the content of eicosapentaenoic acid (EPA) in umbilical cord blood was higher than that in maternal blood and placenta. All differences were significant (P<0.05). Conclusions　Mothers preferentially transport long chain polyunsaturated fatty acids (AA and DHA) through the placenta to meet the needs of fetal and neonatal growth and development.

Correlation between blood glucose fluctuation and brain damage in neonates with hypoglycemia

　LYU Yuan, ZHU Lingling, CHEN Ling, CHEN Liting, LI Hao, LIU Huiping, SHU Guihua

. 2017, 35(9):  652.  doi:10.3969/j.issn.1000-3606.2017.09.004

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Objective　To explore the correlation between the fluctuation of blood glucose levels and brain damage in neonates with hypoglycemia. Methods　The clinical data of 58 cases of neonatal hypoglycemia diagnosed from September 2013 to August 2016 were analyzed retrospectively. According to the results of neonatal cranial MRI and/or amplitude integrated electroencephalogram (aEEG), the neonates were divided into brain injury group and non-brain injury group. The fluctuation index of blood glucose was compared between two groups, and the correlation between the fluctuation of blood glucose level and brain injury was analyzed. Results　In these 58 cases, 13 cases were in brain injury group (8 males and 5 females) and 45 cases were in non-brain injury group (27 males and 18 females). The lowest blood glucose (LBG) value in brain injury group was lower than that in non-brain injury group, while the duration of hypoglycemia, maximum blood glucose fluctuations (LAGE), standard deviation of blood glucose (SDBG), and average blood glucose fluctuations (MAGE) were higher than those in non-brain injury group, and they were all significantly different (P all<0.001). Conclusions　Whether the hypoglycemia in newborn could lead to the brain injury or not depends not only on the minimum hypoglycaemia level and duration of hypoglycemia, but also on the indicators of glucose variation, such as LAGE, SDBG and MAGE.

Analysis of the correlation between copy number difference of ADAM3A gene and congenital diaphragmatic hernia

XIONG Ying, YE Weiping, GU Hang

. 2017, 35(9):  655.  doi:10.3969/j.issn.1000-3606.2017.09.005

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Objective　To evaluate the relationship between the number of copies of genes and congenital diaphragmatic hernia by the detection of multiple loci in infants with congenital diaphragmatic hernia. Methods　Multiple loci were analyzed by Microarray analysis of Affymetrix Cytoscan 750 k in 11 neonates with congenital diaphragmatic hernia, in whom 1 case was twins,and his fraternal twins were diagnosed of fetuse intestinal dilatation. Results　A homozygous deletion (8 p11.22 arr[hg19]) was found in one neonate with congenital diaphragmatic hernia, and was eventually confirmed that the depolymerization of the biotin and metalloprotease (ADAM) 3A genes lead to homozygous deletion of the 1~15 exon. Conclusion　The alteration of ADAM3A copy number may be the cause of congenital diaphragmatic hernia. 

Clinical analysis of non-immune hydrops in 10 fetuses

　CAI Cheng, GONG Xiaohui, QIU Gang, SHEN Yunlin, YAN Chongbing, CHEN Yihuan, SONG Zhijun

. 2017, 35(9):  658.  doi:10.3969/j.issn.1000-3606.2017.09.006

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Objective　To explore the clinical features, diagnosis, and treatment of non-immunologic hydrops fetalis (NIHF). Methods　The clinical data of 10 cases of NIHF in neonatal intensive case unit during January 2011 to December 2016 were analyzed retrospectively. The related literatures were reviewed. Results　In 10 cases of NIHF (6 males and 4 females). the gestational age were 32－42 weeks, and the birth weight was 2.25－3.95 kg. Among them, there were 3 cases of infectious diseases (cytomegalovirus, Streptococcus agalactiae, and parvovirus infection, one case each), 2 cases of fetal cardiovascular abnormalities, 2 cases of chromosomal abnormalities, 1 case of abnormal thoracic structures, 1 case of twin transfusion syndrome, and 1 case of etiology unknown of fetal hydrops. The clinical manifestations showed that there were 8 cases with 2 or more areas of edema (or hydrops), and only 2 cases with skin edema. Finally, 6 cases were cured and discharged, 2 cases were discharged by themself, and 2 cases died. Conclusions　Prenatal ultrasound is a reliable method for the diagnosis of NIHF. Fetal edema in early pregnancy, especially with congenital malformations, is recommended for termination of pregnancy. After birth, NIHF should be diagnosed promptly so as to avoid or reduce severe complications.

Analysis of gene and drug resistance of ESBL producing bacteria in neonatal feces

ZHAO Yanling, Hongyin, SUN Liwei, YIN Chunxia, LI Lihong, ZHANG Xiaojie, DU Kening, YUAN Ying

. 2017, 35(9):  662.  doi:10.3969/j.issn.1000-3606.2017.09.007

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Objectives　To explore the route of ESBL producing bacteria in neonatal faeces, and to investigate the gene and drug resistance of ESBL producing bacteria in intestinal tract of neonates. Methods　Fecal samples of healthy newborns and their mothers were collected, and bacterial cultures were carried out using selective ESBL medium. The positive strains were identified by Time-of-flight mass spectrometry. ESBL genotyping and resistance gene detection were performed by whole genome sequencing technique. Results　In 146 neonatal fecal specimens, the positive rate of ESBL producing bacteria was 8.90%,and the positive rate in the first time stool was 3.23%. Seventy-two hours after birth, the positive rate of fecal ESBL producing bacteria was 13.10%. Among the 13 ESBL producing strains, there were 9 strains of CTX type, 3 strains of TEM type and 1 strain of SHV type. Nine strains of CTX include five types such as CTX-M-24, CTX-M-18, CTX-M-27, CTX-M-42 and CTX-M-15. The positive rate of ESBL producing bacteria was 21.6% in 167 mothers' fecal specimens. The ESBL genotype included 24 strains of CTX type, 6 strains of TEM type, 4 strains of SHV type and 2 strains of QnrS type. Twenty-four strains of CTX include CTX-M-24, CTX-M-14, CTX-M-18, CTX-M-27, CTX-M-42 and CTX-M-15. There were 2 or 3 ESBL genotypes in 12 maternal and neonatal specimens. It was detected to have 6 types of resistance gene such as aadA5, strA, strB, sul1, sul2 and dfrA17 in 49 strains of ESBL producing bacteria in maternal and neonatal strains. Resistance genes were exactly the same in the neonates as in mothers who were detected to have ESBL producing bacteria. A variety of resistance genes were detected in feces in 7 neonates and 23 mothers. Conclusions The neonates in hospital may be detected to have ESBL produing bacteria in the intestinal tract at the same time as their mothers or separately. However, there are many ways for neonates to have ESBL producing bacteria in intestinal tract. There are many genotypes and resistance genes of ESBL producing bacteria.

Clinical and gene analysis of primary carnitine deficiency found by neonatal screening　

　SUN Yun, MA Dingyuan, WANG Yanyun, CHENG Wei, LIANG Xiaowei, JIANG Tao

. 2017, 35(9):  666.  doi:10.3969/j.issn.1000-3606.2017.09.008

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　Objective　To explore the clinical feature and gene types in patients with primary carnitine deficiency. Methods 　Clinical data of 6 patients with primary carnitine deficiency and 2 patients with maternal carnitine deficiency found in the screening by tandem mass spectrometry technology during December 2013 to December 2016 were retrospectively analyzed. Results　The free carnitine levels of 8 patients in initial and recall screening were 5.85±1.65 μmol/L and 5.22±1.02 μmol/L. Two pathogenic alleles were detected in each patient with primary carnitine deficiency by genetic and metabolic disease panel based on Ion Torrent semiconductor sequencing. After treatment with oral L-carnitine, the free carnitine levels of 6 patients with primary carnitine deficiency were 20.24±3.88 μmol/L. The carnitine levels returned to normal after mixed feeding for one week in 2 patients with maternal carnitine deficiency, and no genetic diagnosis was carried out. Conclusion　Primary carnitine deficiency can be effectively detected using tandem mass spectrometry technology and next generation sequencing panel and the prognosis is good with early standard treatment.

Congenital imperforate anus complicated with 22q11.2 deletion syndrome: a case report and literature review

ZHANG Min, ZHU Xiaodong, WANG Pengpeng, XIE Wei

. 2017, 35(9):  669.  doi:10.3969/j.issn.1000-3606.2017.09.009

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　Objective　To explore the clinical phenotype of 22q11.2 deletion syndrome with imperforate anus. Methods　The clinical diagnosis and treatment of one case of 22q11.2 deletion syndrome complicated with anal atresia were retrospectively analyzed. Gene and phenotype of this disease were analyzed, and the related literature was reviewed. Results　An elder male test tube infant of twins, born to a G2P2 mother were found to have special facial features, cleft palate, congenital heart disease, and imperforate anus after birth. A genome-wide microarray scan revealed 22q11.2 deletion syndrome. In related literatures, 22q11.2 deletion syndrome could be affected by TBX1 gene, histone modification, Ranbp1 gene, and even microRNA; while imperforate anus were influenced by multiple elements such as genetic, maternal, and environmental factors and multiple embryonic developments related genes could be involved in its pathogenesis. Conclusions　Congenital imperforate anus and 22q11.2 deletion syndrome are mostly sporadic cases in epidemiology and are incidental accidents in development. Whether there is a common interaction factor between them needs to be further studied and defined.

Research in CaNa2EDTA in the treatment of chronic moderate lead poisoning in children

YING Xiaolan, GAO Zhenyan, MA Wenjuan, WU Meiqin, XU Jian, YAN Chonghuai

. 2017, 35(9):  673.  doi:10.3969/j.issn.1000-3606.2017.09.010

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　Objectives　To explore the efficacy of CaNa2EDTA in the treatment of chronic moderate lead poisoning, so as to optimize the chelation therapy for lead poisoning in children. Methods　The clinical data of 14 patients with chronic moderate lead poisoning treated with CaNa2EDTA for 3 consecutive courses of lead removal during September 2014 to December 2016 were analyzed retrospectively. Twenty-four hour urinary lead levels during hospitalization were analyzed. The changes of blood lead levels before treatment, 3 days, and 5 days after treatment were also analyzed. Results　In the 14 children (4 males and 10 females) average age was 2.35±1.47 years. After treatment with CaNa2EDTA for 3 consecutive courses, the blood lead levels were decreased significantly in all the patients, and the blood lead levels at 3 days after treatment were 0.76, 0.77, 0.72 times those at 5 days after treatment respectively. The decrease of blood lead levels per unit of drug in the first 3 days of treatment were significantly higher than those in 5 days of treatment (P<0.05). The decrease of blood lead levels at 3 days after treatment was 0.65, 0.71, 0.70 times , those in 5 days’ treatment respectively. The decrease of urine lead levels per unit of drug in the first 3 days of treatment were significantly higher than those in 5 days of treatment (P<0.05). Conclusions　CaNa2EDTA has an obvious effect on removal of lead.The efficiency of lead removal in 3 days of treatment was higher than in 5 days of treatment. Thus, a course of treatment for 3 days may be an altenative for a course of 5 days.

Long term follow-up of children with neuroblastoma without chemotherapy and radiotherapy

　ZHAO Jie, PAN Ci, XU Min, ZHOU Min, GAO Yijing, HU Wenting, TANG Jingyan

. 2017, 35(9):  678.  doi:10.3969/j.issn.1000-3606.2017.09.011

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　Objectives　To analyze the clinical features and long-term follow-up results of neuroblastoma (NB) without chemotherapy and radiotherapy, and to provide evidence for further improvement of treatment. Methods　The clinical data of children diagnosed with NB who received operation during January 2005 to December 2015 was retrospectively analyzed, and the long-term follow-up results were evaluated. Results　In 57 cases of NB, 43 cases (81.1%) were in stage 1, 8 cases were in stage 2 and 2 cases were in stage 4S. The median age at diagnose was 7 months (11 days - 10 years and 11 months). There were 47/51 cases had the pathological type with a good prognosis (accounting for 92.2%). FISH was detected in 1/49 case which had the amplification at greater than 10 copies. 56/57 cases underwent surgical resection of the primary tumor, 50 cases of which were completely resected, and 3 cases had very good partial remission after tumor resection. The abdominal mass was found in the uterus in 1 case, and surgical operation was not performed and the imaging was regularly checked for follow-up , and the mass subsided completely at 7-month-old. The median follow-up time was 36 months (4 - 99 months). Five children were lost to follow-up and the median time of follow-up was 19 months (4 - 45 months). One child in stage 4S relapsed at 1 year of follow-up, 2 cases in stage 1 relapsed at 6 months of follow-up. Five years event free survival rates (EFS) in all patients were 94.6%, and overall survival rate (OS) of the 5 years was 100%. Conclusions　Children younger than 18 months without MYCN amplification in the stages 1 and 2 are safe by surgical treatment alone with good prognosis. Simple surgical treatment can also be extended to all age groups of NB without MYCN amplification in the stages 1 or 2.

Clinical and genetic analysis of a family with low alkaline phosphatase

　LU Weicheng, SHI Congcong, CAI Dong, ZHENG Xu, HAO Hu, XIAO Xin

. 2017, 35(9):  682.  doi:10.3969/j.issn.1000-3606.2017.09.012

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Objective　To investigate the role of TNSALP gene detection in prenatal diagnosis of HPP. Method　The clinical data and the results of complete exon sequencing of TNSALP gene  in one neonate with low alkaline phosphatase (HPP) were analyzed retrospectively. Peripheral bloods from his family members were collected. The amniotic fluid cell in fetuses at 17 weeks was tested for candidate gene mutations by Sanger sequencing. Results　Mainly manifestations in 6-day-old baby were multiple fractures, limb shortening and bending and dyspnea. He died of respiratory failure 9 days after birth. The serum alkaline phosphatase was decreased and serum calcium was decreased slightly; serum phosphorus, serum 25 hydroxyvitamin-D and parathyroid hormone were normal. X-ray showed that the whole body bone was very poorly mineralized, and the long diaphysis was enlarged with shape of a cup at the end and multiple fractures existed. Gene sequencing revealed a complex heterozygous missense mutation in the TNSALP gene, including the heterozygous missense mutation c.542C>T in exon sixth causing 181st amino acids changed from serine to leucine (p.S181L), and tenth exon heterozygous missense mutation in c.1016G>A causing 339th amino acid changed from glycine to glutamic acid (p.G339E). The parental phenotypes were normal. The c.542C>T mutation is inherited from his father and the c.1016G>A mutation is inherited from his mother. These two mutations were not detected in the fetus. Conclusion　TNSALP gene analysis can be applied to the diagnosis and prenatal diagnosis of HPP.

Childhood fibrillary glomerulonephritis: one case report and literature review

　ZHANG Hongwen,CUI Jieyuan,SU Baige, YAO Yong

. 2017, 35(9):  687.  doi:10.3969/j.issn.1000-3606.2017.09.013

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　Objective　To explore the clinical features, diagnosis, and treatment of childhood fibrillary glomerulonephritis (FGN). Methods　The clinical data of a child with FGN in April 2016 were analyzed retrospectively. Results　A 12-yearold boy, who presented significant proteinuria (mainly albumin), hypoalbuminemia, hypercholesterolemia, and persistent microscopic hematuria in May 2010, met the criteria of nephrotic syndrome. Renal biopsy in May 2010 showed mesangial proliferative glomerulonephritis combined with glomerulosclerosis. It was not effective by treatment with intravenous infusion of methylprednisolone and prednisolone, and there were no responses by the combination with mycophenolate mofetil and traditional Chinese medicine. After admission, the second renal biopsy was performed. Under the light microscope, the moderate mesangial proliferative glomerulonephritis combined with membranoproliferative changes was observed. Under the electron microscope, the FGN was confirmed. Conclusion　The first case of childhood FNG was diagnosed in China.

Hereditary polycythemia caused by mutation of ANK1 gene: a case report

　ZHANG Dan, WAN Wuqing

. 2017, 35(9):  691.  doi:10.3969/j.issn.1000-3606.2017.09.014

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　Objective　To explore the genetic characteristics, diagnosis, and treatment of hereditary spherical polycythemia (HS). Methods　The clinical data of one case of HS was analyzed retrospectively, and related literatures were reviewed. Results　The 5-year-old girl presented hemolytic anemia from 6 months old. Incubation of fragility tests was positive. Blood smears and red cell electron microscopy showed spherical red blood cells. DNA sequencing showed alterations in heterozygosity of stopgain SNV. The girl was diagnosed was HS, and was scheduled to undergo splenectomy at 6 years old. Conclusions　HS is an autosomal dominant genetic disease, mainly manifested as anemia, hemolytic anemia, and splenomegaly. The early diagnosis depends on genetic testing.

Infantile Sandhoff disease: a case report and literature review

ZHAN Liping, LI Dongfang, LI Pinggan, LIANG Liyang, LUO Xiangyang, HUANG Ke

. 2017, 35(9):  694.  doi:10.3969/j.issn.1000-3606.2017.09.015

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Objective　To summarize the clinical manifestations, diagnosis, and treatment of infantile Sandhoff disease. Methods　The clinical data of one case with infantile Sandhoff disease were reviewed retrospectively. The related literatures were reviewed. Results　The girl aged 1 year and 2 months suffered from psychomotor regression and intractable convulsions. The parents were consanguineous marriage. The fundus microscopy showed fundus erythema. Brain magnetic resonance imaging showed an abnormal signal of long T2WI and identical T1WI at left pons, white matter edema, and diffuse demyelination. No abnormal karyotype was observed. A chromosome microarray suggested multiple large homozygous chromosomes segments. The second generation gene sequencing showed deletion of c.1263_1268delTGAAGT:P. (Glu422_Val423del) deletion in exon 11 and a shear mutation of c.1614_2A>G:P? in intron 13 of HEXB gene which were carried by her parents respectively . The activity of HexA, HexA & HexB were 84 and 112 nmol?mg−1?h−1, respectively. Finally, this girl was diagnosed of infantile Sandhoff's disease. After treatment with valproate, levetiracetam combined with antiepileptic and glucocorticoids, episodes of convulsions were decreased gradually, and the reaction was better than before. In 5 months of follow up, the condition was stable, and no progression and no seizures exist. Her mother got pregnant again and received an amniocentesis on her 21+6 weeks of pregnancy, and results suggest that the fetus had the same mutation as this girl. Conclusions　Sandhoff's disease is a type of rare hereditary lysosomal disease, characterized by progressive neurological impairment. Currently there are no effective treatments. Genetic testing is helpful in the diagnosis and prenatal diagnosis.

Intervention effects of bone marrow mesenchymal stem cells on viral myocarditis in mice

XIE Yuan, WU Tingting, LI Ping, WANG Xuliang, WU Rongzhou

. 2017, 35(9):  698.  doi:10.3969/j.issn.1000-3606.2017.09.016

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　Objective　To explore the effects of bone marrow mesenchymal stem cells (BMSCs) on viral myositis in mice. Methods　Four-week-old BALB/C male mice were randomly divided into normal control group, myocarditis group, and BMSCs intervention group at different stages (3 days and 2 weeks). The mouse model of viral myocarditis was established by intraperitoneal injection of Coxsackie virus B3. The mice in the intervention group were injected with BMSCs in the tail vein at 3 days and 2nd week after the injection of the virus. Four weeks later, echocardiography was performed, and the pathological integral and collagen volume fraction (CVF) were observed and calculated by light microscopy. The qRT-PCR method was used to detect the mRNA expression of homogenates collagen I (col1α1) and collagen fiber III (col3α1) in myocardial tissue. Results　Compared with the normal control group, the left anterior and posterior wall became thinner, the diameter and volume of the left ventricle at end systolic period was increased; left ventricular ejection fraction (LVEF) and short axis shortening rate (FS) decreased in the myocarditis group. The differences were statistically significant (P all<0.05). The LVEF and FS in each subgroup of the intervention group were better than those of the myocarditis group, and the improvement in the intervention group was more obvious at the 2nd week after the treatment of the myocarditis. The differences were significant (P all<0.05). Light microscope showed that myocardial CVF in myocarditis group was higher than in normal control group, and CVF in intervention group was reduced compared with myocarditis group and CVF in the 2nd week intervention group was lower than that in the 3 day intervention group. The differences were significant (P all<0.05). Compared with the control group, the mRNA expressions of col1α1 and col3α1 in the myocarditis group were increased, and they were lower in the intervention group than in the myocarditis group, and the differences were significant (P all<0.05). Conclusions　BMSCs can reduce the degree of cardiac fibrosis and improve cardiac function in mice with viral myositis, and the intervention effect is better when the virus is infected in the 2nd week.

The research progress in the relationship between the number of nucleated red blood cells and neonatal diseases

LI Hao, YANG Yinying

. 2017, 35(9):  703.  doi:10.3969/j.issn.1000-3606.2017.09.017

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　Nucleated red blood cells (nRBCs) are immature red blood cells, which are rarely in circulating blood in elder children, but often present in neonatal blood. The clinical significance in neonates is unclear. Numerous studies have shown that many kinds of acute and chronic stimuli can lead to an increase in the number of nRBCs in circulating blood. This article reviews various pathological processes related to the production and release of nRBCs, and emphasizes the effects of acute and chronic hypoxia and immune regulation on it.

Research progress in promoting and hindering factors of breastfeeding in hospitalized premature infants

YANG Yuanyuan

. 2017, 35(9):  708.  doi:10.3969/j.issn.1000-3606.2017.09.018

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　According to WHO, breastfeeding is the best for premature babies. Breastfeeding are beneficial for health of both mothers and their premature infatns and as well as reduction of medical and health expenditure. However, the breastfeeding rate in premature infants is still unsatisfactory so far, especially in those premature infants admitted to NICU in the early life. This article review promoting and hindering factors of breastfeeding in hospitalized premature infants from the following aspects: the characteristics of premature infants, the demographic and sociological characteristics, knowledge, beliefs, and psychological status of mothers, hospital policies and support, and family support.

Risk factors for renal scarring in children　

SUN Yu

. 2017, 35(9):  713.  doi:10.3969/j.issn.1000-3606.2017.09.019

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　Renal scarring can cause hypertension, proteinuria, chronic kidney disease, and even end stage renal disease. To understand the risk factors of renal scarring in children is helpful for its early detection, diagnosis, prevention, and treatment. High grade vesicoureteric reflux, recurrent urinary tract infection, and delayed treatment are risk factors for kidney scarring. However, there are still some controversies about the relationship between renal scarring and the some factors such as gender, age, and congenital factors. Recent studies have found that noninvasive urine indicators such as urine neutrophil gelatinase associated lipid delivery protein, urinary endothelin-1, and risk prediction models can predict the formation of renal scar. However, prophylactic use of antibiotics can reduce occurance of urinary tract infections, but do not reduce the risk of renal scarring. This article reviews the possible risk factors and predictors of renal scarring in children, providing a basis for early detection, timely intervention, and effective prevention of it in clinic, so as to reduce the formation and progression of renal scarring.