There are more complicated pathological changes in the developing brain with invasive infection of central nervous system(CNS) which absolutely play predominant role in neurodevelopmental disability and mortality in spite of a lower prevalence during neonatal period.Bacterial meningitis demonstrated by cerebrospinal fluid(CSF) culture only remain difficult since poor positive findings,in the severe condition more complications could be often found such as vasculitis,ventriculitis,cerebritis and abscess.Cerebral abscess could be found independently without abnormal CSF examination;while the cerebritis is one of the primary pathological changes in viral invasive infection of CNS,Enterovirus/human parechovirus often involved not only grey matter,but also the periventricular and subcortical white matter that sound similar to the findings of periventricular leukomalacia on magnetic resonance imaging(MRI).Finding the complications of CNS infections early and accurately describe pathological changes by reasonable using MRI can enhance the therapy and predictive ability.

Current definition of apnea of prematurity (AOP) with the time of breathing cease equal or more than 20 seconds,or less than 20 seconds accompanying with bradycardia and(or) cyanosis was absence of strong clinical evidence and arbitrary.We have no consensus on the treatment of AOP,but severe AOP will lead to the intermittent hypoxic episodes(IHE) and severe fluctuation of oxygen saturation associated with severe retinopathy of prematurity and bad neurodevelopmental outcome.IHE occurred not only due to AOP,but also in the processes of continuous positive airway pressure and invasive ventilation.Decreasing the IHE is one of key problems of preterm respiratory support.Optimal target oxygen saturation should be regulated dynamically,the target oxygen saturation of 90％ ～ 95％ lowers IHE and mortality,but likely increases retinopathy of prematurity.Caffeine,the first choice of AOP,may be no of effect in the mixed or obstructive AOP which may need more respiratory support to reduce the lung volume loss and airway resistance.

ObjectiveTo explore the diagnosis value of color Doppler ultrasound of the carotid atherosclerosis plaques in diabetic patients. MethodsColor Doppler ultrasonic assessment of carotid was performed in 124 diabetic patients(test group)and 100 normal controls(control group).The intima-media thickness(IMT)and the carotid atherosclerosis plaques parameters were measured.The results were compared and analyzed between two groups. ResultsThe IMT and the incidence rate of carotid atherosclerosis plaques in the test group were higher than those in the control group(all P＜0.05).There was no statistical difference in the site of the plaques between test and control group(P＞0.05). ConclusionThe incidence rate of the carotid atherosclerosis of type 2 diabetes was higher.Carotid color Doppler ultrasonography was an optimal technique for screening and diagnosing atherosclerosis.

Despite that improved neonatal intensive care unit therapies have reduced the mortality of preterm neonates, neo-natal neurodevelopmental morbidity persists at high rates. There is increasing recognition that following perinatal brain injury, cognitive deifcits in preterm neonates can often occur in the absence of signiifcant impairment and cerebral palsy often due to non-severe white matter injury (WMI). Minicystic and diffusive white matter lesions that need MRI detecting make up the predominant role in the preterm brain injury. The target cells and tissue of WMI in the preterm infant not only focus to preoligodendrocytes and white matter, but also involve neurons and grey matter. In fact, brain developmental trajectory in the premature infant with WMI is a mixed disorder of destructive and dysmature processes. Current MRI applied with high resolution could detect the punctate and diffusive WMI at early stage, distinguish the hemorrhagic lesions from reactive gliosis, analyze cerebral metabolism, and even describe the developmental progresses of myelination, ifber tract, cortex and cerebral connectome. But the predictive value of dif-ferent MRI techniques in brain development requires more and long-term research through the all life stages.

Although respiratory distress syndrome( RDS) ,one of the most common cause of respira-tory failure in the very or extremely preterm infant,has not been yet the major disorder of death with advances of respiratory support;In fact,RDS often complicated with BPD which developed with the maturation of de-pendence,the outcome of BPD and its development step into the focus of modern NICU. Powerful evidence-based consensus and suggestions have been stated in early respiratory support for very and extremely preterm infant:Early nasal CPAP( nCPAP) should be the best alternative to intubation for very or extremely preterm infant with high-risk of RDS and RDS; Early administration of Pulmonary surfactant ( PS ) with suitable methods( InSurE,Intubation Surfactant Extubation or LISA,Less invasive surfactant administration);Individ-ual threshould for nCPAP or other noninvasive ventilation failure should be established,but early PS adminis-tration and gentle ventilation will decrease the incidence of ventilator-induced injury on failuring noninvasive ventilation;Noninvasive ventilation with the use of caffeine will short the duration of ventilation and improve the success of weaning off. All the strategies in respiratory support to prevent BPD for very preterm infant still need more practice sustain improvement since multiple causes account for the development of BPD.

Objective To study the clinic effect and safety of inhaled nitric oxide for the neonates with hypoxic respiratory failure. Methods A total of 21 neonates with hypoxic respiratory failure were trea-ted with nitric oxide inhalation after ineffective treatment of conventional mechanical ventilation. The values of mean airway pressure( MAP) ,oxygenation index( OI) ,mean blood pressure and saturation of blood oxy-gen percutem( TcSaO2 ) were detected before and after nitric oxide inhalation. Meanwhile,the values of coag-ulation function,nitrogen dioxide concentration and methaemoglobin were monitored. Results The lung oxy-genation of 21 cases were significantly improved in 48 hours after nitric oxide inhalation,OI declined from 26. 600 ±4. 169 to 7. 500 ±1. 716,MAP decreased from(15. 100 ±2. 132)cmH2O(1 cmH2O=0. 098 kPa) to (8. 000 ± 0. 816) cmH2O,which all had statistical differences(P <0. 01). The monitoring of coagulation function was in the normal range. The levels of methaemoglobin were less than 3% and nitrogen dioxide less than 1 × 10 -6 . In this study,18 neonates survived,2 neonates died and 1 neonate gave up treatment. Conclu-sion Inhaled nitric oxide early can improve oxygenation effectively for neonates with hypoxic respiratory failure without obvious side-effect. However,it is not yet clear for its long-term prognosis and whether there is influence development of the nervous system.

Objective To evaluate the diagnostic value of (1,3)-β-D-glucan assay (G test) in the plasma of premature infants with invasive fungal infection(IFI) and determinate the best diagnostic value of G test.Methods The premature infants who were at risk of IFI from NICU were enrolled in Shengjing Hospital of China Medical University from July 2010 to September 2011.The concentration of (1,3)-β-D-glucan were detected by GKT-5MSet microbial dynamic detection system,and the fungal and bacterial culture were performed in the same samples of blood.We used to perform statistic analysis for sensitivity,specificity,positive predictive value and negative predictive value at different cutoff values,and draw receiver operating characteristic curve for G test.Results Forty-four infants were eligible for the study,of 17 permature infants with IFI,and of 27 ones with non IFI,in whom bacterial culture was positive in 12 cases and culture was negative in 15 cases.The concentration of (1,3)-β-D-glucan in IFI group [5 ～ 3 117 pg/ml,median (Q75-25)190.60(501.44) pg/ml] was higher than that in non IFI group[5.0 ～434.3 pg/ml,median(Q75-25) 5.86(5.62) pg/ml],the difference was significant(Z =-3.77,P ＜ 0.01).15 pg/ml was the best cutoff value,and the area under curve was 0.839,95 ％ CI(0.697,0.980).Conclusion G test is useful in the diagnosis of IFI in premature infants with high sensitivity and specificity.G test can be used for the screening of high-risk patients with high risk of fungal infection ratio.

OBJECTIVE:To explore the effect of Fuyuan capsule on the mRNA expression of HIF-1? in kidney of sepsis rats. METHODS:Male SD rats were randomly divided into sham group,model group and Fuyuan capsule group (low dose and high dose) with 4 rats in each group. CLP operation was done in Fuyuan capsule groups after four days of intragastric administration. RT-PCR testing was applied to determined the expression of HIF-1a in 3 h,6 h,12 h and 24 h after model induction. The level of IL-6 was measured by ELISA method. Blood of heart was sampled for detection of renal function. HE staining was used to observe pathological change of kidney. RESULTS:As compared with sham group,the mRNA expression of HIF-1? increased gradually within 3 h and reached peak at 24 h(P

Objective To investigate the imaging features in neonates with hypoglycemic brain injury by early and serial MRI.Methods Neonates who were admitted to neonatal department from May 2005 to Jul 2013 received MRI and diffusion-weighted imaging(DWI) scan within 7 days after hypoglycemia.Fortynine neonates were diagnosed with hypoglycemic brain injury.Thirty-four neonates received second MRI scan between 2 ～3 weeks after hypoglycemia.Seven neonates received third MRI scan.Results All the 49 neonates showed hyperintensity on DWI in the regions of occipital and parietal lobe for the first MRI scan(mainly involved 33 cases).Six cases combined frontal lobe and temporal lobe.Ten cases presented widespread cortex and white matter involvement.All the cases presented hypointensity on DWI for the affected area,T1 and T2 weighted image signal changes were not obvious.Some cases presented deep white matter and gray matter injury.Thirty-four cases received second MRI scan between 2 ～3 weeks after hypoglycemia,20 presented hypointensity on DWI,hypointensity on T1 weighted image and hyperintensity on T2 weighted image.Eleven cases with normal signals,and the other 3 were absorbing.Seven cases received third MRI scan,appeared encephalomalacia,myelin retardation,white matter volume decreased,hypoplasia of corpus callosum.The more severe the clinical symptoms was,the more severe the degree of brain injury showed.Conclusion Cerebral occipital and parietal regions are the most vulnerable in neonatal hypoglycemic brain injury.Early DWI for the imaging diagnosis of hypoglycemic brain injury should be taken within one week after hypoglycemia.Mild injury is recoverable,but severe would chang into necrosis and encephalomalacia.Some combined deep white and gray matter injury might related to hypoxia and ischemia.

Objective To understand the distribution of pathogen and antibiotic resistance of nosocomial fungal infection,and provide evidence for the prevention of fungal infection in premature infants in hospital.Methods The clinical data of 72 cases of premature infants with nosocomial fungal infections were retrospectively analyzed.Results The top three of the pathogenic of fungal infection in premature infants in our hospital were 38 strains of Candida pelliculosa (52.8％,38/72),10 strains of Candida albicans (13.9％,10/72),9 strains of Candida parapsilosis (12.5％,9/72).The weights of 72 cases with nosocomial fungal infection in preterm infants were below 2000 g,who were dominated by very low birth weight infants.Gestational age of 27 ～ 30 weeks were in the majority,which accounted for 36.1％ of 27 ～ 28 weeks (26/72) and 34.7％ of 29 ～30 weeks (25/72),each group were dominated by bacteria pathogen candida.Seventy-two strains of fungi were isolated to amphotericin B drug resistance,the 1.4％ (1/72) resistance rate to fluconazole,4.2％ (3/72) pairs of voriconazole resistance rate,2.8％ (2/72) for itraconazole resistant rate.There were no significant differences among the last three resistant rate (x2 =1.02,P ＞ 0.05).The 5-fluorine cytosine resistance accounted for 59.7％ (43/72),and the 4 kinds of drug resistance rate had significant difference (x2 =57.73,P ＜ 0.05).There was no significant difference in resistance rate between amphotericin B and fluconazole (x2 =1.01,P ＞ 0.05).Conclusion Fluconazole could be used to those premature infants with high risk factors of fungal infection.Once the fungal infection is diagnosed,intravenous fluconazole could be the first choice,when necessary,amphotericin B can be used together.