新生儿脑水肿的病因与早期诊断探讨

为了降低新生儿脑水肿(NBE)的病死率与伤残率,对其病因与早期诊断作探讨以利防治.资料分析方法1.回顾性分析,尸检证实NBE 583例(1962～1998年).2.对生后3～7天经头颅CT检查确诊NBE的63例作症候分析(1998～1999年).资料显示1.583例NBE的原发病依次脑267例,肺223例,感染52例,心35例,畸形6例.2.63例CT扫描结果SAH60例,HIE48例,IPH、脑积水各2例,SDH、ⅣH、脑梗塞各1例.3.临床表现以兴奋或抑制、呼吸改变、青紫或苍白、肌张力异常、反射异常为明显.可以认为1.本组NBE的病因以缺氧为主.2.当患儿具有窒息,异常分娩史,母为高危妊娠,产前、产时有合并症和生后具有上述症候者,应作头颅CT或超声,可早期诊断脑水肿.     

Effect of Target-directed Regulation of Uncoupling Protein-2 Gene Expression on Ischemia-reperfusion Injury of Hepatocytes

The effect of target-directed regulation of the uncoupling protein-2 （UCP-2） gene expression on the ischemia-reperfusion injury of hepatocytes under different conditions was investigated. The expression plasmid and RNAi plasmid targeting UCP-2 gene were constructed and trans- fected into normal hepatocytes and fatty liver cells, respectively. The expression of UCP-2 mRNA was detected by real time PCR. The cells were divided into normal cell group （NCG）, group of normal cells transfected with empty vector （EVNCG）, group of normal cells transfected with expression plasmid （EPNCG）, fatty liver cell group （FCG） and group of fatty liver cells transfected with RNAi plasmid （RPFCG）. The ischemia-reperfusion model in vitro was established. One, 6, 12 and 24 h after reperfusion, Annexin V/PI flow cytometry was used to measure cell necrosis rate, apoptosis rate and survival rate. Simultaneously, the intracellular ATP, ROS and MDA levels were determined. The re- sults showed that 1, 6, 12 and 24 h after ischemia-reperfusion, the intracellular ROS, MDA and ATP levels and cell survival rate in EPNCG were significantly lower, and cell necrosis rate significantly higher than in NCG and EVNCG, but there was no significant difference in apoptosis rate among NCG, EVNCG and EPNCG （P〉005）. Six, 12 and 24 h after reperfusion there was no significant dif- ference in ROS, MDA levels and apoptosis rate between FCG and RPFCG （P〉0.05）, but the ATP level and survival rate of cells in RPFCG were higher than in FCG （P〈0.05）. It was concluded that down-regulation of the UCP-2 gene expression in steatotic hepatocytes could alleviate the ische- mia-reperfusion injury of liver cells.     

Lewis肺癌细胞趋化因子受体OXOR4表达的研究

目的：观察趋化因子受体CXCR4在Lewis肺癌细胞和肿瘤组织中的表达，为探讨CXCR4与肿瘤转移的关系提供研究基础。方法：体外培养Lewis肺癌细胞，并建立Lewis肺癌细胞皮下种植瘤模型与自发性转移模型，采用RTPCR和蛋白质印迹法分析培养细胞和肿瘤组织中CXCR4mRNA及蛋白质表达水平；应用免疫组化方法分析Lewis肺癌原发瘤和转移瘤中CXCR4表达，并通过迁移实验观察CXCR4特异性配体SDFla对Lewis肺癌细胞的趋化作用。结果：培养Lewis肺癌细胞及肿瘤组织中均功能性地表达趋化因子受体CXCR4，且其表达水平与细胞所处氧环境有关；低氧能够促使Lewis肺癌细胞CXCR4蛋白表达增高，与对照组相比差异有统计学意义，t=4．051，P=0．009。12h细胞趋化运动实验显示，CXCR4特异性配体SDF-1α可剂量依赖性诱导Lewis肺癌细胞的趋化运动，在低氧条件下，同对照组相比SDF-1α质量浓度为25ng／mL时开始促进细胞迁移，t=3．053，P=0．031；SDF-1α质量浓度为50ng／mL时可明显提高细胞迁移率，t=4．521，P=0．004。结论：Lewis肺癌细胞功能性表达趋化因子受体CX—CR4，可能与肿瘤细胞迁移和转移有关。     

不同维持剂量枸橼酸咖啡因对辅助通气早产儿的疗效评估:一项初步多中心研究北大核心CSCD

目的探讨需要辅助通气和枸橼酸咖啡因治疗的早产儿枸橼酸咖啡因的最佳维持剂量。方法回顾性收集2019年1月1日至2019年12月31日江苏省30家三级医院新生儿重症监护病房中需要辅助通气和枸橼酸咖啡因治疗的早产儿566例(胎龄≤34周)的临床资料。依据生后24 h内给予枸橼酸咖啡因负荷剂量20 mg/kg后接受高(每日10 mg/kg)或低(每日5 mg/kg)维持剂量治疗将早产儿分为高剂量组(n=405)和低剂量组(n=161)。对两组早产儿咖啡因应用期间有创/无创通气相关数据进行比较分析。结果与低剂量组比较,高剂量组早产儿辅助通气时对高浓度氧的需求明显降低(P<0.05),无创通气撤除后的吸氧总时间及住院期间总吸氧时间均显著缩短(P<0.01),再次无创通气的比例明显降低(P<0.01),肺表面活性物质及吸入性布地奈德的使用率均显著减少(P<0.05),呼吸暂停及BPD的发生率显著降低(P<0.01),但早产儿喂养不耐受的发生率明显上升(P=0.032)。两组在体重变化、早产儿视网膜病变发生率、脑室内出血发生率、坏死性小肠结肠炎发生率、病死率、咖啡因应用时间等方面比较差异无统计学意义(P>0.05)。结论初步多中心研究表明高维持剂量枸橼酸咖啡因(每日10 mg/kg)对治疗我国早产儿人群总体是有益的,并未增加常见不良反应的发生。而对于喂养不耐受的风险,还需要进一步的论证分析,以尽可能排除混杂因素的干扰。     

Early risk factors for death in neonates with persistent pulmonary hypertension of the newborn treated with inhaled nitric oxide北大核心CSCD

Objective To evaluate the early risk factors for death in neonates with persistent pulmonary hypertension of the newborn (PPHN) treated with inhaled nitric oxide (iNO). Methods A retrospective analysis was performed on 105 infants with PPHN (gestational age ≥34 weeks and age <7 days on admission) who received iNO treatment in the Department of Neonatology, Children's Hospital of Nanjing Medical University, from July 2017 to March 2021. Related general information and clinical data were collected. According to the clinical outcome at discharge, the infants were divided into a survival group with 79 infants and a death group with 26 infants. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for death in infants with PPHN treated with iNO. The receiver operating characteristic (ROC) curve was used to calculate the cut-off values of the factors in predicting the death risk. Results A total of 105 infants with PPHN treated with iNO were included, among whom 26 died (26/105, 24.8%). The multivariate Cox regression analysis showed that no early response to iNO (HR=8.500, 95%CI: 3.024-23.887, P<0.001), 1-minute Apgar score ≤3 points (HR=10.094, 95%CI: 2.577-39.534, P=0.001), a low value of minimum PaO2/FiO2 within 12 hours after admission (HR=0.067, 95%CI: 0.009-0.481, P=0.007), and a low value of minimum pH within 12 hours after admission (HR=0.049, 95%CI: 0.004-0.545, P=0.014) were independent risk factors for death. The ROC curve analysis showed that the lowest PaO2/FiO2 value within 12 hours after admission had an area under the ROC curve of 0.783 in predicting death risk, with a sensitivity of 84.6% and a specificity of 73.4% at the cut-off value of 50, and the lowest pH value within 12 hours after admission had an area under the ROC curve of 0.746, with a sensitivity of 76.9% and a specificity of 65.8% at the cut-off value of 7.2. Conclusions Infants with PPHN requiring iNO treatment tend to have a high mortality rate. No early response to iNO, 1-minute Apgar score ≤3 points, the lowest PaO2/FiO2 value <50 within 12 hours after admission, and the lowest pH value <7.2 within 12 hours after admission are the early risk factors for death in such infants. Monitoring and evaluation of the above indicators will help to identify high-risk infants in the early stage. © 2022 Xiangya Hospital of CSU. All rights reserved.     

不同起始时间应用咖啡因对早产儿安全性及有效性的评估：一项江苏省多中心研究

目的 评估早产儿（胎龄≤31周）早期和晚期使用咖啡因的有效性和安全性。方法 从江苏省8家医院的新生儿重症监护室中回顾性选取640例胎龄≤31周的早产儿作为研究对象,其中早期应用咖啡因510例（生后≤72 h开始应用;早期应用组）,晚期应用咖啡因130例（生后>72 h开始应用;晚期应用组）。比较两组早产儿的临床资料。结果 早期应用组和晚期应用组在出生体重、Apgar评分、性别、胎龄、入院年龄等方面的比较差异无统计学意义（P > 0.05）。早期应用组咖啡因应用起始日龄和撤除日龄小于晚期应用组（P < 0.05）;早期应用组咖啡因应用时间短于晚期应用组（P < 0.05）。两组之间入院时呼吸支持情况的比较差异无统计学意义（P > 0.05）。早期应用组呼吸暂停发生率低于晚期应用组（P < 0.05）;早期应用组用氧时间和住院时间短于晚期应用组（P < 0.05）。早期应用组支气管肺发育不良发生率和家庭氧疗率显著低于晚期应用组（P < 0.05）。两组出院时新生儿颅内出血、脑室周围白质软化、坏死性小肠结肠炎、早产儿视网膜病变、动脉导管未闭的发生率和纠正胎龄40周时新生儿神经行为评分的比较差异均无统计学意义（P > 0.05）。两组的病死率比较差异亦无统计学意义（P > 0.05）。结论 早产儿（胎龄≤31周）早期应用咖啡因可显著缩短咖啡因应用时间、用氧时间和住院时间,且无明显不良反应。     

不同新生儿危重评分对极低及超低出生体质量儿出院前结局预测价值

目的 寻找预测极低出生体质量(VLBW)儿和超低出生体质量(ELBW)儿出院前结局的敏感的评分指标。方法 收集2018年7月1日至2021年1月31日收治的VLBW儿和ELBW儿的临床资料。评估新生儿急性生理学评分-Ⅱ(SNAP-Ⅱ)、新生儿急性生理学评分围生期补充-Ⅱ(SNAPPE-Ⅱ)、新生儿临床危险指数(CRIB)及新生儿危重病例评分(NCIS)对VLBW儿和ELBW儿出院前死亡、坏死性小肠结肠炎、支气管肺发育不良、肺出血、脑室旁白质软化及视网膜病变的预测价值。结果 共收治VLBW儿 491例,经筛选最终纳入223例VLBW儿(含56例ELBW儿)。无论VLBW儿或ELBW儿,存活组的NCIS评分高于死亡组,SNAP-Ⅱ、SNAPPE-Ⅱ以及CRIB评分均低于死亡组,差异均有统计学意义(P<0.05)。在VLBW儿中,经ROC曲线分析发现,CRIB评分预测VLBW儿死亡的AUC最大,AUC为0.888,95%CI为0.827～0.949,当CRIB评分为1.5时,其预测VLBW儿死亡的约登指数为0.672,灵敏度0.944,特异度0.728。在ELBW儿中,CRIB评分预测...     

全髋关节与人工股骨头置换治疗老年人股骨颈骨折临床疗效情况及对术后远期并发症发生率的影响分析

目的：分析全髋关节与人工股骨头置换治疗老年人股骨颈骨折临床疗效情况及对术后远期并发症发生率的影响。方法：选取2017年1月—2019年10月吴川市人民医院骨三科住院治疗的230例老年股骨颈骨折患者作为研究对象,以双盲随机抽样法分为参照组和观察组,每组各115例。参照组采纳全髋关节置换术治疗,观察组采纳人工股骨头置换术治疗,对比两组患者手术指标、临床疗效、Harris评分、VAS评分、血清炎症因子、并发症发生率。结果：观察组手术时间、住院时间均短于参照组,观察组术中出血量、术后引流量均低于参照组,差异有统计学意义(t=36.891、16.947、71.015、39.958,P<0.05);观察组临床总有效率与参照组比较,差异无统计学意义(χ²=0.518,P>0.05);治疗后,观察组Harris评分与参照组比较,差异无统计学意义(t=1.167,P>0.05),治疗后观察组VAS评分低于参照组,差异有统计学意义(t=26.770,P<0.05);治疗后,观察组血清IL-6、TNF-α均低于参照组,差异有统计学意义(t=15.404、29.6...     

人类肥胖相关新基因LYRM1原核表达载体的构建及其在大肠杆菌中的表达

目的构建人类肥胖相关新基因LYRM1原核表达载体,并获取LYRM1重组蛋白。方法采用RT-PCR技术从人网膜脂肪组织中扩增出LYRM1基因的完整编码框,将其亚克隆到原核表达载体pGEX-6P-1,转化大肠杆菌BL21(DE3),用异丙基-β-D-硫代板乳糖苷(IPTG)诱导LYRM1融合蛋白的表达,利用变性聚丙烯酰胺凝胶电泳(SDS-PAGE)及免疫蛋白印迹(Western blot)鉴定其表达。结果PCR、酶切鉴定及测序结果表明重组质粒构建正确。LYRM1基因在原核细胞中成功表达,经SDS-PAGE鉴定融合蛋白相对分子质量约为40000,主要以不可溶的包涵体形式存在于菌体沉淀中,Western blot分析表明融合蛋白具有免疫原性。结论成功扩增和克隆了人类肥胖相关新基因LYRM1,并通过构建其原核表达载体,使其在大肠杆菌中高效表达,为进一步研究该基因的功能奠定了基础。     

极低体重儿肺炎治疗探讨

为了提高极低体重儿肺炎的治愈率,通过对６７例ＶＬＢＷＩ肺炎临床表现和治疗的分析,我们认为ＶＬＢＷＩ肺炎以产前感染肺炎为主,其特点为：１．发病早;２．主要通过吸入污染的羊水引起感染;３．临床表现不典型,４．病原菌以革兰氏阴性杆菌为主,对氨苄青霉素耐药,可首选头孢氨噻肟或头孢三嗪;５．合并症多。