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OBJECTIVE: It is clinically insufficient to assess the severity and prognosis of neonatal asphyxia only according to Apgar score and blood gas measurement. In order to find more sensitive and specific indexes, the clinical significance of cord blood lactate in neonates with asphyxia was studied. METHODS: The lactate level and the pH value of cord arterial blood were determined in 31 term infants with perinatal asphyxia (further divided into the mild and the severe asphyxia groups) and 30 normal neonates (the control group). At the 14th day after birth, 20 item neonatal behavioral neurological assessment (NBNA) was taken for each subject. RESULTS: The levels of cord blood lactate in the mild and severe asphyxia groups [( 6.42 ± 0.14 ) and ( 10.77 ± 0.12 ) mmol/L] were significantly higher than that in the control group [( 4.20 ± 0.15 ) mmol/L](P< 0.01 ). The pH values in the mild and severe asphyxsia groups were markedly lower than that of the control group [( 7.16 ± 0.07 ) vs ( 7.18 ± 0.11 ); ( 7.04 ± 0.09 ) vs ( 7.18 ± 0.11 )](P< 0.01 ). There were significant differences in the lactate level and pH value between the mild and severe asphyxia groups (P< 0.01 ). The lactate level was negatively correlated with the pH value and the score of NBNA (r= -0.76 and -0.85 , respectively, both P< 0.01 ). CONCLUSIONS: Cord blood lactate may be a useful index in evaluating the severity and short term prognosis in neonates with perinatal asphyxia.

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OBJECTIVE: Retinopathy of prematurity (ROP) is one of important causes of childhood visual impairment and blindness. Many research has shown that low birth weight (BW) and low gestational age (GA) are primary risk factors for ROP. This paper aims at studying the other high risk factors involved in the development of ROP. METHODS: Sixty four preterm infants with and without ROP were divided into two groups: a ROP group and a control group without ROP (n=32 for each). The clinical data of the two groups were studied by case contrast study according to the paired design of GA and BW. Logistic regression analysis was done for 20 possible risk factors. RESULTS:The odds ratios of the duration of oxygen therapy (DOT), maximal PaO 2 (MaxPaO 2), pregnancy induced hypertension (PIH) and minimum pH value within the first 3 days of life (MinpH) were 2.764 , 2.175 , 1.935 and 2.417 respectively (P< 0.01 ). The logistic regression equation of the risk factors in preterm infants with ROP was Logit (P)=β 0+1.265 DOT+1.034 Max PaO 2+0.936 PIH-1.273 MinpH (χ 2= 25.634 , P< 0.01) . CONCLUSIONS: The long time of oxygen exposure, hyperoxia, PIH and acidosis are high risk factors in the development of ROP.

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OBJECTIVE: The CT values of brain tissue of premature infants are usually low and it is difficult to assess if they stand in the normal range of CT values of premature infants. This paper aims at studying the differences of brain CT values between the premature and term infants. METHODS: Seventy six premature infants were divided into 2 groups according to the gestational age: 28-33 +6 weeks group (n=36) and 34-36 +6 weeks group (n=40). Fifty term infants were used as the control group. The cranial CT scan was taken and the CT values of various regions of brain tissues were measured. RESULTS: The CT values of cerebellum, brainstem, basal segment, thalamus, white matter and grey matter in the two premature infants groups were significantly lower than those in the control group (P< 0.01 ). The CT values of the above regions of brain tissues in the 28-33 +6 weeks group were significantly lower than those in the 34-36 +6 weeks group (P< 0.01 ). CONCLUSIONS: This study shows that the brain CT values of the premature infants are significantly lower than those of the term infants, thus the reference range of the brain CT values of full term neonates is not fit for the premature newborns.

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OBJECTIVE: Some research has shown that prolactin (PRL) is closely related to severity of hypoxic ischemic encephalopathy (HIE). However, the role of maternal and neonatal plasma PRL levels in neonatal asphyxia has not been reported so far. This paper aims at studying the changes of PRL levels in the cord blood, maternal blood and plasma of newborns in neonatal asphyxia. METHODS: The maternal blood, cord blood and neonatal plasma PRL levels in 25 neonates with asphyxia (asphyxia group) and 20 normal ones (control group) were detected by radioimmunoassay. RESULTS: The maternal blood, cord blood and neonatal plasma PRL levels [( 362.5 ± 127.1 ), ( 984.6 ± 262.3 ) and ( 386.3 ± 216.2 ) μg/L, respectively] in the asphyxia group were significantly higher than those in the control group [( 96.4 ± 26.2 ), ( 92.3 ± 18.4 ) and ( 68.7 ± 7.27 ) μg/L, respectively] (P< 0.01 ). The maternal blood, cord blood and neonatal plasma PRL levels [(445±216), (996±284) and (412±221) μg/L, respectively] in the severe asphyxia group were higher than those in the mild asphyxia group [(298±102), (612±221) and (309± 19.2 ) μg/L, respectively] (P< 0.01 or 0.05 ). The cord blood and neonatal plasma PRL levels had a positive correlation both in the mild and the severe asphyxia group (r= 0.54 , r=0.63, both P< 0.05 ). The plasma PRL level right after resuscitation was higher than that of the control group (P< 0.01 ). It gradually reduced from the 2nd day after birth, but was higher than that of the control group (P< 0.01 ). The PRL level on the 10th day after birth was not different from that of the control group. CONCLUSIONS: The PRL levels of neonatal plasma, cord blood and maternal blood increase in the perinatal asphyxial newborns. The plasma PRL level may be a good marker to evaluate the degree of asphyxia.

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OBJECTIVE: To explore the efficacy of cord blood stem cell transplantation (CBSCT) for treatment of myelodysplastic syndrome (MDS) in children. METHODS: A 12 year old child with MDS received the treatment of HLA matched sibling CBSCT. The pre treatment regimen was “BU/CY+ATG” [busulfan (BU) with the dosage of 1 mg/kg, once every 6 hrs, and 8 times in all; cyclophosphamide (CY) with the dosage of 50 mg/kg daily for 4 days and antihuman thymocyte globulin (ATG) with the dosage of 100 mg daily for 4 days]. After pre treatment, 2.57 ×10 7/kg of cord blood nucleated cells and 1.18 ×10 5/kg of CD 34 positive cells were transplanted into the child with MDS. The combination of cyclosporine A, mycophenolate mofetil and ET methylprednisolone was administrated for prevention of graft versus host disease (GVHD). After transplantation the patient was given a combination of granulocyte colony stimulating factor, interleukin 11 and erythropoietin to promote reconstitution of hematopoiesis. RESULTS: The reconstitution time of granulocyte cell and platelet were respectively 21 days and 48 days. Microsatellite DNA fingerprinting showed a full donor chimerism on day 28 after transplantation. In an 11 month follow up, the patient did not develop GVHD and other transplantation related complications. CONCLUSIONS: It is the first case report in China on the successful treatment of MDS by CBSCT, which can provide guidelines for the future treatment of childhood MDS.

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OBJECTIVE: Neonatal asphyxia may lead to multiple organ lesions. This paper aims at studying the changes of β 2 microglobin (β 2 MG) in blood and urine and N Acetyl β D Glucosaminidase (NAG) in urine so as to evaluate the renal function in neonates after asphyxia. METHODS: Radioimmunity and colorimetry were used to simultaneously measure β 2 MG levels in blood and urine and urinary NAG level in 28 neonates with neonatal asphyxia and 16 healthy neonates. RESULTS: Compared with healthy infants, the levels of β 2 MG in blood and urine and the level of NAG in urine [( 4.46 ± 1.42 ) mg/L vs ( 2.97 ± 1.24 ) mg/L, ( 2.69 ± 1.80 ) mg/L vs ( 0.96 ± 0.82 ) mg/L, ( 13.68 ± 2.01 U/mmol.Cr vs ( 6.12 ± 1.16 ) U/mmol/Cr, respectively] significantly increased in neonates with asphyxia (P< 0.01 ). The levels of β 2 MG in blood and urine and the NAG level in urine [( 4.99 ± 1.28 ) mg/L, ( 3.86 ± 1.14 ) mg/L, ( 13.94 ± 3.82 ) U/mmol.Cr, respectively] were significantly higher in the neonates with severe asphyxia than those in neonates with mild asphyxia [( 4.30 ± 1.21 ) mg/L, ( 2.93 ± 0.87 ) mg/L, ( 9.68 ± 1.27 ) U/mmol/L.Cr, respectively](P< 0.05 ). The levels of β 2 MG in urine increased more obviously than the β 2 MG level in blood in neonates with asphyxia (P< 0.01 ). CONCLUSIONS: β 2 MG in blood and urine and NAG in urine may be useful indexes for the early evaluation of renal function, especially of the orientation of injury of glomerular or renal tubular and of the severity of renal lesions in neonates following asphyxia.

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OBJECTIVE: Nutrition insulin like growth factors (IGFs) axis is important to body catch up growth and gastrointestinal development, while gastrointestinal development is closely related to the nutritional absorb and catch up growth in infants with intrauterine growth retardation (IUGR). Now there are few reports about the postnatal intestinal development of IUGR infants in our country, and the reports have mainly focused on the gastrointestinal morphology and structure of new born IUGR rats. This research aims to study the effects of early postnatal diet with different levels of protein and caloric on serum IGF 1, IGFBP3, intestinal development and catch up growth in rats with IUGR. METHODS: The IUGR rat model was established by nutrition restriction. Sixty four IUGR pups were randomly assigned into four groups: the IUGR model group, the IUGR high protein diet group, the IUGR low protein diet group and the IUGR high caloric group. The rats in the four groups were fed with a normal protein, a 30% protein and a 10% protein diets, and a diet with caloric being higher by 20% than the other three groups respectively. Sixteen normal pups receiving normal diet were served as the control group. The serum concentrations of IGF 1 and IGFBP3, body weight, body length and intestinal weight and length were measured at the 4th and 12th weeks after birth respectively. RESULTS: The IUGR high protein diet and high caloric diet groups manifested quick intestinal development and catch up growth, as well as the increased IGFs level; the IGFs level of the IUGR high protein diet group at the 4th week after birth was significantly higher than the other groups (P< 0.05 ). The IUGR model group manifested a relatively slow intestinal development and catch up growth and a non increased IGFs level. The body weight, body length and intestinal weight and length in the IUGR low protein diet group at the 4th and 8th weeks after birth were lower than those of other groups and the IGFs level was lower at the 4th after birth compared with that of the other groups (P< 0.05 ). The IGFs level was positively correlated to body weight, body length and intestinal weight and length at the 4th after birth (r= 0.930 , 0.884 , 0.678 , 0.978 respectively, all P< 0.05 ). At the 12th week after birth, there was no correlation among them. CONCLUSIONS: IGF 1 is a sensitive index reflecting catch up growth and is positively related to intestinal development and body catch up growth during childhood (4th week of life), while the correlation disappears at adulthood (12th week of life).

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OBJECTIVE: The issue of enteral feeding becomes a hotspot with the increasing survival rate of premature infants. Intermittent nasoduodenal feeding (INDF) is a common method of feeding premature infants in China and more discussion is needed at whether intermittent nasogastric feeding (INGF) is better than INDF. This paper aims at comparing the effects of INDF and INGF on nutrient intake, physical growth, feeding related complications, and serum prealbumin (PA) level in premature infants shortly after birth. METHODS: Forty premature infants (birth weights ranging from 1 050 g to 1 920 g) were randomly assigned into INDF and INGF groups that were fed with the same formula. The amount of liquid, caloric and protein intakes, variation of physical growth parameters (e.g. body weight, length and head circumference), stool characters, and feeding related complications were recorded in the first week of initial feeding. The serum PA level was detected by ELISA 1 week before and 1 week after feeding. RESULTS: After the first week the amount of milk input, caloric and protein intakes were significantly higher in the INDF group than those in the INGF group (P< 0.01 ). The time taken to reach the caloric value of 418.4 kJ /kg daily by enteral feeding and the birth weight regaining time in the INDF group were significantly shorter than those in the INGF group (P< 0.05 ). There was no significant difference in the increase of length and head circumference between the two groups. The serum PA level in the INDF group by the end of the first week was higher than that in the INGF group (P< 0.05 ). There were no occurrences of diarrhea and necrotizing enterocolitis in the two groups. The incidence of feeding related complications, such as aspiration pneumonia, vomiting and gastric residue, was lower in the INDF group than that in the INGF group, but no significant difference was found. The incidence of hyperbilirubinemia was significantly lower in the INDF group than that in the INGF group (P< 0.01 ). CONCLUSIONS: In premature infants fed by INDF the amount of nutrition intake may increase, feeding related complications may decrease during the initial feeding and nutritional situations may be better than in those premature infants fed by INGF.

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OBJECTIVE: Henoch Schnlein purpura (HSP) is an autoimmune vasculitis syndrome of unknown etiology. Recently, some research has shown that the polymorphisms of Mannose binding lectin (MBL) gene can decrease the serum MBL level, and MBL deficiency may be associated with increased susceptibility to infection and autoimmune diseases. This study aims at exploring the correlation between MBL codon 54 polymorphism and HSP in Han nationality children. METHODS: One hundred and four children with HSP and 160 healthy controls were enrolled in this study. The genotypes of MBL gene 54 codon were detected by Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR RFLP). RESULTS: The genotype frequency of heterozygote (GGC/GAC) in the HSP group was significantly higher than that in the healthy controls ( 51.9% vs 25.0% ) (P< 0.05 ), whereas that of homozygote (GGC/GGC) in the former was significantly lower than that of the latter (46.2% vs 73.8%) (P< 0.05 ). The allele frequency of GAC was higher in HSP patients than that in controls ( 0.279 vs 0.138 ) (P< 0.05 ), whereas that of GGC in HSP patients was lower than that in controls ( 0.721 vs 0.862 ) (P< 0.05 ). The variant allele (GAC) was markedly associated with onset of HSP (OR= 2.46 , 95% CI= 1.32 - 4.48 ; P< 0.05 ). In addition, in the HSP group more patients carrying the variant allele (GAC) had episodes of upper respiratory or gastrointestinal infections before onset of HSP compared with those with GGC homozygote (P< 0.05 ). CONCLUSIONS: MBL gene condon 54 mutation might be related to the pathogenesis of HSP.

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OBJECTIVE: Viral myocarditis frequently occurrs in children, but no effective medicines for clinic treatment have been found. This paper aims at studying the effect and mechanism of astragalus injection in the treatment of acute murine myocarditis caused by Coxsackievirus B 3. METHODS: Acute viral myocarditis was induced in 24 Balb/c mice by injection of Coxsackievirus B 3m (CVB 3m ) intraperitoneally. Half of the mice were administered astragalus injection with a dosage of 10 g/kg daily for 7 days (astragalus treated group). The remained received the same amount of normal saline and were used as the control group. On the 8th day after CVB 3m infection, the pathological changes of myocardium were studied. Myocardial perforin expression was detected by reverse transcription polymerase chain reactin (RT PCR) and serum TNF α level was measured by radioimmunoassay. RESULTS: The astragalus treated group showed a significant reduction in myocardial lesions compared with that in the control group. The myocardial perforin expression in the astragalus treated group was much lower than that in the control group [( 1.10 ± 0.07 ) vs ( 1.31 ± 0.12 ); P< 0.01 ]. The serum TNF α level was also significantly lower in the astragalus treated group than that in the control group [( 2.39 ± 0.21 ) vs ( 2.97 ± 0.32 ; P< 0.01 )]. The myocardial perforin expression was significantly positively correlated with the serum TNF α level (r= 0.84 , P< 0.01 ). CONCLUSIONS: Astragalus has protective effects against viral myocarditis by reducing perforin mediated cytotoxicity and inflammatory reaction.

Abstract:

OBJECTIVE: The mechanism of infantile hemangioma is not clearly understood and some research has shown that vascular endothelial growth factor (VEGF) is closely related to the vascular endothelial cell proliferation. This paper aims at probing into the role of VEGF in the development of infantile hemangioma. METHODS: Ninety specimens from congenital vascular disorders of skin were studied. Fifty six were from hemangioma (32 hemangiomas in the proliferating phase and 24 ones in the involuting phase) and 34 were from vascular malformation. VEGF, receptor of VEGF (VEGFR/KDR) and proliferation cell nuclear antigen (PCNA) were detected by immuohistochemical method. RESULTS: The levels of expression of VEGF, VEGFR/KDR and PCNA in proliferating hemangioma were higher than those in involuting hemangioma, vascular malformation and normal tissue (P< 0.01 ), and there were no significant differences among the latter three tissues. CONCLUSIONS: VEGF and VEGFR may promote the growth of hemangioma. The detection of VEGF, VEGFR/KDR and PCNA may be useful in clinical differential diagnosis between hemangioma and vascular malformation.

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OBJECTIVE: The cause of Guillain Barre Syndrome (GBS) is still not clear. Some researchers thought that it was related to infection, especilly Campylobacter jejuni (CJ) infection. This paper aims at studying the relationship between CJ infection and Ganglioside GM 1 injury so as to explore the mechanism of GBS. METHODS: The levels of CJ IgG antibody and the antibodies of ganglioside GM 1 IgG and GM 1 IgM were detected by enzyme linked immunosorbent assay in serum or cerebrospinal fluid of 31 children with GBS. Of the 31 patients, there were 23 cases of acute inflammatory demyelinating polyradiculo neuropathy (AIDP) and 8 cases of acute motor axonal neuropathy (AMAN). Thirty three children with non GBS neurological diseases (NGBS group) and 10 normal children were used as the control groups. RESULTS: The serum CJ IgG levels in both acute and recovery phases in the AMAN group were significantly higher than those of the NGBS group (P< 0.01 ); and the serum anti CJ IgG level in the acute phase in the AIDP group also significantly increased compared with that of the NGBS group (P< 0.01 ). The CJ IgG levels in cerebrospinal fluid in acute phase in the AMAN and AIDP groups were higher than that of the NGBS group (P< 0.01 ). The serum GM 1 IgM levels in both acute and recovery phases in the AMAN and AIDP groups were higher than those of the two control groups (P< 0.05 ). The serum GM 1 IgG level was higher than that of the normal control group, but it did not differ from that of the NGBS group. There were significant differences in the GM 1 IgM level in the cerebrospinal fluid between the GBS group and the NGBS group (P< 0.05 ). CJ IgG was positively correlated to GM 1 IgG and GM 1 IgM (R= 0.722 , P= 0.05 ). CONCLUSIONS: CJ infection may be an important cause of in the development GBS. The immunological injury of ganglioside GM 1 may be related to the pathogenesis of GBS.

Abstract:

Castleman's disease (CD) is a localized or systemic angiofollicular lymphoproliferative disorder of unknown etiology and pathogenesis and rarely seen in children. The disorder manifest lymph node hyperplasia with or without systemic symptoms and can be classified to unicentric CD (UCD) and muticentric CD (MCD). The histological features include three types: hyaline vascular, plasma cell and mixed variant. The diagnosis of CD was comfirmed by lymph node biopsy. No effective treatment for patients with MCD has been found so far and some of which may be respondent to corticosteroid and interferon α. The patients with UCD can be improved by surgical intervention with/or radiotherapy.

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